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NR 506 Week 6 Graded Discussion Topic: Using the Media
NR 506 Week 6 Graded Discussion Topic: Using the Media Given the power of the media, discuss how you would use an opinion editorial, a personal intervie... [Show More] w, websites, texting, Facebook, Twitter, and/or blogs to influence public opinion relative to your policy priority. What concerns about media and electronic social networking do you need to consider? Why? ANSWER There has never been more immediate access to information from around the globe than there is in today’s computerized, technology rich world. The use of social media has increased dramatically over the past decade. Because of this increased use and exposure, people tend to trust what they see on social media. Hopman et. al. (2015) report that repeated exposure to social media results in increased trust based on societal assumptions that media sources target their consumers with the intent to foster trust. As a result of this, it is easy to disseminate information, and misinformation, rapidly to a wide variety of recipients, some of whom are able to validate and comprehend the information, some of whom are not and inherently take this information at face value, based on assumptions of trustworthiness. For this reason, it is important that these platforms are used judiciously in order to disseminate factual, accurate information. On the subject of the use of an Automated External Defibrillator (AED) in public spaces, social media is a platform that can get the message out to a large audience in a short period of time. Personal interviews can be broadcast and shared, websites are already in place and being kept up to date, blogs, infomercials, instructional videos and narrative videos can be posted and shared via social platforms such as Facebook, Twitter, Instagram, and Tik Tok. Information can be shared regarding heart disease and its impact on the population; sudden cardiac arrest, treatment for this condition, and the lasting effects of survival; and the impact of CPR in conjunction with defibrillation using and AED. Sutherland et. al. (2018) found that there is a positive relationship between participation in a Facebook group and the degree of offline physical participation, in addition to a feeling of being connected to the community, which is a critical component to the success of an AED program. One of the concerns about the use of social media is the prevalence of cyberbullying which is a verbal attack via an electronic platform that is aggressive and intentional towards another who is unable to easily defend oneself (Hamm et. al., 2015). This phenomenon is receiving significant amounts of attention these days due to the frequency and intensity of online attacks, where the bully if often faceless, anonymous, and free from being held accountable for their words and/or actions. This anonymity has emboldened bullies whose attacks can have instant, significant and lasting effects on the recipient. As an author or producer of an on-line product, one must be diligent in monitoring comments to mitigate the presence of bullying comments and actions. This will help ensure the credibility and validity of the message, and keep interested people engaged in the message. Nadine Quarshie, RN References Hopman, D. N., Shehata, A., & Stromback, J. (2015). Contagious media effects: How media use and exposure to game-framed news influence media trust. Mass Communication and Society, 18, 776-798. https://doi.org/10.1080/15205436.2015.1022190 Sutherland, K., Davis, C., Terton U., & Visser, I. (2018, March). University student social media use and its influence on offline engagement in higher educational communities. Student Success, 9(2), 13-24. https://doi.org/10.5204/ssj.v9i2.400 Hamm, M. P., Newton, A. S., Chisholm, A., Shulhan, J., Milne, A., Sundar, P., Ennis, H., Scott, S. D., & Hartling, L. (2015). Prevalence and effect of cyberbullying on children and young people: A scoping review of social media studies. JAMA Pediatrics, 169(8), 770-777. https://doi.org/10.1001/jamapediatrics.2015.0944 Nadine, I can't agree with you more that the increase use of technology and social media has increased significantly during the pandemic. Additionally, social media is one of the powerful communication tools in today’s healthcare environment. It can reach to the public, private and nonprofit sector and many more area so quickly. Social media has changed the way people obtain or access information globally. It also allows positive and negative values, perceptions and expectation from a wide range of populations. Although social media provide a platform to address issues and reaching your target population it also create a challenge of maintaining credibility. Please discuss the difference between communication tools in young-adult, middle-age adult, and older-adult target audiences. Dr Tyson and Fellow Classmates Being able to communicate across the generations is critical to being able to market your idea, get support from stakeholders, deliver your message and inspire participation from a variety of community members, including political and financial supporters. Sponaugle (2019) advises being aware of how the target recipient(s) prefer to receive or access information, as opposed to utilizing your own preferred techniques. People of any age can participate or assist in the delivery of bystander CPR and the use of an AED, so it is critical in the proposal, development, and implementation of this idea to use a variety of communication techniques and media platforms in order to be inclusive and collaborative with the community in general. Generation Z (mid 1990’s to now) are the youngest generation, and as such, are very technology driven and media savvy. This group could be targeted using more entertaining platforms such as Facebook pages, YouTube videos, Twitter messages, and Tik Tok vignettes. Middle agers such as Millenials (1981-1996) and Gen X (1965-1980) are finding their way in our technology driven world but are more information and data driven, and as such, can be targeted via websites, blogs, and on line journals. Older adults, such as the Baby Boomers (1946-1964) and the Silent Generation (1928-1945) tend to be mature and established, and the least familiar with technology driven media, and as such, can be targeted using short, brief, factual infomercials and videos, on line newspapers and journals, as well as sites networking sites such as Linkedin. No matter what the subject matter or the target audience, it is important to be flexible, understanding, compassionate, and empathetic in order to cater to the needs of the recipient instead of blinded by your own preferences. Nadine Quarshie, RN Reference Sponaugle, S. (Winter 2019). Communicating across generations. Economic Development Journal, 18(1), 16-23. https://eds-b-ebscohost-com.chamberlainuniversity.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=1&sid=75770a9e-1c42-408a-9094-a40d3e09282f%40pdc-v-sessmgr04 [Show Less]
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NR 506 Week 4 Graded Discussion Topic: Challenges in Lobbying
NR 506 Week 4 Graded Discussion Topic: Challenges in Lobbying Discuss the best approach for meeting and communicating with your selected elected officia... [Show More] l for your healthcare concern. What is your rationale for this approach? ANSWER The best approach for meeting and communicating with my selected official, Rep. Elijah Cummings, is to request an appointment through his local office so that he can prepare for the meeting and it will not be an intrusion (Longley, 2017). Although congressional representatives also take meetings when they are in Washington, D.C., they are usually much busier there have more of their time blocked out for them for official business. At the appointed time, I will come prepared with a brief list of questions, since legislators do not have much time to meet with each constituent. I will also bring a one-page summary of my topic and the key facts I will talk to him about; I will leave this with him when I leave, so that he will have a record of the most important information from the meeting. My rationale for this approach is that according to a 2013 CMF survey, 95% of the representatives asked looked at “staying in touch with constituents” as the #1 factor in being effective legislators, so I can assume that Rep. Cummings will want to speak with me (Longley, 2017). My rationale is also based on the fact that Rep. Cummings is one of two legislators who introduced a $100 billion bill to address the opioid epidemic, so I know he is already deeply concerned about this issue and will be interested in talking about it (Lopez, 2018). My rationale for keeping the meeting brief is so that the meeting will not inconvenience him and also to bring greater impact to the few key facts we will discuss. My rationale for leaving a summary of the key facts is so that he will be equipped to discuss them with other legislators, which will strengthen the impact of my visit with him. If the meeting with the legislator goes well, there may be an opening to build on it and develop an ongoing relationship with him, providing further information and staying involved in the legislative process. Many lobbyists have formed long-lasting relationships with legislators, which is a win-win strategy for both. For the legislator, a relationship with a lobbyist can mean access to information from someone who actually works in the healthcare field and who can provide feedback from other healthcare professionals on proposed or passed bills. For the lobbyist, a relationship with a legislator can provide access to discuss any new legislation affecting healthcare-related discussions. These advantages make an ongoing relationship with a legislator a good idea for any nurse who wants to be an advocate and influencer for nursing and general healthcare legislation. The already established relationship means that when lobbying needs to occur in the future, the nurse does not need to start from the beginning but can call upon the legislator he already knows. References Longley, R. (2017, May 8). How to meet your members of Congress face-to-face: The most effective form of advocacy. ThoughtCo. Retrieved from https://www.thoughtco.com/meeting-with-your-members-of-congress-3322076 Lopez, G. (2018, Apr. 24). The Senate is advancing a bill to fight the opioid crisis. It’s still not enough. Vox. Retrieved from https://www.vox.com/policy-and-politics/2018/4/24/17275746/senate-opioid-crisis-response-act-congress [Show Less]
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NR 506 Week 2 Assignment: Identification of Healthcare Policy Concern
Identification of Healthcare Policy Concern NR 506 Week 2 Assignment: Identification of Healthcare Policy Concern Chamberlain University College of Nur... [Show More] sing NR 506: Health Care Policy Identification of Heathcare Policy Concern One of the core components of nursing care and nursing practice is to provide “quality evidence-based care and support to individuals and populations to improve health and well-bring throughout life” (Donovan & Warriner, 2017, p. 21). One way nurses can achieve this goal is to identify community healthcare issues, advocate for solutions, and work with officials in order to enact change that provides legislative support to the practices and programs that help to produce improved outcomes for a healthier population. This paper will discuss an overview of healthcare policy, will identify a community healthcare policy concern, describe a proposed solution to the healthcare concern, and identify an elected official who will be included in the solution to the concern. Overview of Healthcare Policy In general terms, health care policy is the fiscally responsible creation of intentional guidelines, procedures and practices to achieve a desired outcome for the betterment, safety, and well-being of the population. The implementation of healthcare policies that provide for a safer and healthier population have a positive impact on individuals, communities, and the healthcare system in general, inclusive of its providers and funding sources. With a healthier population driving consumption of healthcare services, the general trend should be towards more education, maintenance, and supportive activities as opposed to the reactionary, treatment based, “fix-it” mindset that is currently prevalent in the United States. Donovan & Warriner (2017) feel that healthcare should be moving more towards a service that promotes wellness as much as it treats illness, with programs that improve both physical and mental health for the individual as well as the community. As some of the most collaborative and holistic providers in the field of healthcare, registered nurses, and Advanced Practice Nurses (APN) in particular, can imbed themselves as integral components of programs that focus on wellbeing, disease prevention, patient safety, and holistic health practices. Inspiring people to adopt lifestyle changes to improve their health status requires expert skill at the individual, system, and community level, and there is none who is better poised to implement this skill than nurses in general, and highly educated, advanced practice nurses in particular. The groundwork for such immense change has to start with local advocacy. To advocate one must simply support a cause or issue, and embark on regulatory initiation or reform in a public forum. As an APN, it is essential to advocate for health care changes and in order to gain public approval and/or acceptance, it is critical to enlist the guidance and support of an elected official who has an interest in the community they serve, and has their best interests at heart. Community Healthcare Concern A community healthcare concern that I have identified is the availability of an Automated External Defibrillator (AED) in public locations (along with training in its use in conjunction with CPR). Without legislation to require the presence of an AED in public areas, it is up to the “owner” of the space to decide if one will be available or not. Current North Carolina (NC) legislation, House Bill 914 (2012) states that “According to the American Heart Association, an individual goes into cardiac arrest in the United States every two minutes. In North Carolina, twenty-three percent (23%) of all deaths are attributed to heart disease.” but only requires an AED in government buildings. Baekgaard et. al. (2017) report 300,000-350,000 annual out of hospital cardiac arrests internationally. Average survival rates are less than 10% without early defibrillation, and these chances decrease with every minute that passes. With the implementation of AEDs in the general community, survival rates can be as high as 50%-70%. According to the American Heart Association, Benjamin et. al. (2018) report that heart disease is the #1 cause of death in the United States; 356,460 people, or 1 out of every 7.4 people will suffer an out of hospital sudden cardiac arrest (SCA) with 90% of these events being fatal; 25% of victims will have shown no prior symptoms of heart disease, and 19.8% of these events will be because of Ventricular Fibrillation (VF) or Pulseless Ventricular Tachycardia (PVT). Statistics show that 39.5% of these events occur in public places, and 37% are witnessed. While the use of bystander CPR has increased from 36.5% in 2006 to 40.7% in 2016, the use of an AED in conjunction with CPR has only reached 5.7% in 2016, up from 3.2% in 2006. Hansen et. al. (2015) found that in the state of NC, when SCA occurs, early bystander/first responder CPR and defibrillation resulted in a greater chance of not only survival, but survival with a good neurological outcome. Their statistics show that for the time period of 2010-2013, after a statewide initiative for community based CPR and AED education and training, there was an increase in delivery of CPR and defibrillation from 14.1% to 23.1%; survival to hospital discharge increased from 9% to 13.9%, and survival with good neurological outcomes increased from 7.1% to 9.7%. The evidence gleaned from this data clearly shows that the initiation of bystander/first responder CPR in conjunction with defibrillation has a positive impact on the survival rates, recovery and health status of victims of SCD. Based on this evidence there is room for improvement by way of expansion of this requirement to more public spaces than just government buildings. The community that will be discussed in this paper is Walkertown, NC. Walkertown is a small, rural town that is approximately 11-14 miles from the nearest hospital, about a 15-20 minute car drive. The median age in Walkertown is 41.7 years old, with 52% of the population being over 40 years of age, and 25% over 60 years of age (Census Reporter, 2018). Using the above mentioned statistics, it can be predicted that in Walkertown alone, there is potential for 1 person to suffer a SCA every hour. If in a public facility, that one person would be relying on the quick response of the general public to save his/her life. Without the availability of an AED, there is a better chance than not that the victim will not survive. Establishing a policy wherein public facilities are required to supply and AED with properly trained personnel can change the face of survival rates of SCA in this quaint town. With conclusive data from a small area such as Walkertown, using the incrementalist model for policy making, this data could be introduced at the General Assembly level and proposed for adoption across the entire state. Such a policy, with support from a local elected official could positively change the lives of many people, reducing the number of deaths and disability associated with SCA and influencing evidenced based, positive health care change within the state of NC. Proposed Solution to the Healthcare Concern It is my proposal that an AED should be required in any public spaces that can hold a large number of people in a gathering for a period of time beyond quickly “running in”. These public spaces would include (but not be limited to) libraries, churches, schools, restaurants, gyms, shopping spaces, and both indoor and outdoor sporting venues. Current legislation in NC does not require an AED in locations such as these; however, Walkertown, NC could begin a life-saving chain of policy reform events. Stakeholders of this proposal would be business owners, service providers and neighbors-at-large, all of whom play an integral role in the success of the proposal. Changes that would be required from the community stakeholders would be support of the proposal, adoption of the proposal, purchase and install of the AED, as well as provision of initial and ongoing training. Those most affected by the changes are the elderly and persons who congregate in public spaces, and although not every resident falls in those categories at present, they more than likely will at some point. Challenges that should be anticipated are financial responsibility, monitoring of the program past its initial adoption, and perceived value or importance to the community. Financial impact can be reduced via grant applications and negotiation with area retailers based on volume purchasing. Data collection and monitoring of the program can be assigned to the local Fire Department, and perceived value and importance can be enhanced via local advertising, community announcements, town mailers, and public service announcements in the area. The intended outcome is that there will be less loss of life due to out-of-hospital SCA in Walkertown, North Carolina. The effect of this proposal, once implemented, can be enumerated via data collected through mandatory reporting criteria that will show a positive impact in the community via improved survival rates. The proposal would be implemented along with a program that guides the initiation of the program, initial education and training, ongoing/renewable training, mandatory reporting criteria, as well as maintenance required to maintain functionality of the device. With the proper education, training and maintenance of the AED, the device would be readily available for bystanders to use in the unfortunate event of a SCA. Changes that would be required from the community stakeholders such as business owners and service providers would be support of the proposal, adoption of the proposal, purchase and install of the AED, as well as provision of initial and ongoing training. Many AED retailers will do a site assessment and then provide pricing based upon needs. This site assessment could be requested by the Town Council once the number needed has been determined. Pricing typically includes the AED, accessories, and assistance to develop a maintenance program that must be followed to ensure proper function of the device. It is recommended that these maintenance programs are implemented, as the Sudden Cardiac Arrest Foundation (2019) finds that poor maintenance of the AED such as expired pads, dead batteries, and malfunctioning cables and pads cause nearly half of AED failures. Private training centers charge an average of $50-$70/person for initial training, however, with the prevalence of health care centers in the area, there is potential for collaboration with a smaller financial impact. Identified Elected Official Advocacy for AED’s in public facilities must start at home, in Walkertown, as the responsibility of an advanced practice nurse with leadership provided by a local elected official. I have selected Mr. Wesley Hutchins, Mayor Pro Tem and lifetime community member as the official to whom I plan to present my proposal. Mr. Hutchins was selected due to his presence in public servitude related to healthcare through his employment experience as Dean of Emergency Services at Forsyth Technical Community College. He holds a Masters of Public Admiistration (MPA) from Grand Canyon University focusing on Disaster Preparedness and Crisis Management. His LinkedIn profile further highlights that he is skilled in dealing with nonprofit organizations, budgeting, operations management, coaching, and emergency management. Mr. Hutchins has recently retired from his parallel position as Fire Chief of Walkertown, NC. He is a community figure known for his advocacy and guidance in the realm of human services for nearly 50 years. Conclusion The evidence is clear: cardiac disease with resultant SCA is a prevalent health problem. Without immediate CPR and defibrillation, SCA is almost always fatal. Bystander CPR with accompanying defibrillation has a positive impact on survival rates as well as neurological function for the survivor. NC legislation that addresses availability of AEDs is outdated and insufficient. Policy changes begin at a local level. Forward thinking approaches and educated policy making are accomplished via presentation, conversation, education, and collaboration so that a community can perpetuate its appreciation for, and of, one another. As a public figure and political leader, Mr. Wesley Hutchins, Mayor Pro Tem of Walkertown, NC can initiate conversations with public facilities’ leadership and their stakeholders to bring Automated External Defibrillators (AEDs) into public locations so as to thwart certain death in the event of an out-of-hospital SCA. As an advanced practice nurse, I can provide additional guidance and support utilizing evidence based data and statistics, in the realm of education, use of, and maintenance of the AED. I may have individually identified this healthcare concern, however with effective communication and collaboration with community leaders and stakeholders; together we can create the spark that begins a flame. References Baekgaard, J. S., Viereck, S., Moller, T. P., Ersboll, A. K., Lippert, F, & Folke, F. (2017). The effects of public access defibrillation on survival after out-of-hospital cardiac arrest: A systematic review of observational studies. Circulation, 136(10), 954-965, http://doi.org/10.1161/CIRCULATIONAHA.117.029067 Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Chiuve, S. E., Cushman, M., Delling, F. N., Deo, R., de Ferranti, S. D., Ferguson, J. F., Fornage, M., Gillespie, C., Isasi, C. R., Jimenez, M. C., Jordan, L. C., Judd, S. E., Lackland, D., . . . Muntner, P. (2018). Heart disease and stroke statistics-2018 update: A report from the American Heart Association. Circulation, 137(12), e67-e492, http://doi.org/10.1161/CIR.0000000000000558 Census Reporter (2018). Walkertown, NC. https://censusreporter.org/profiles/16000US3770660-walkertown-nc/ Donovan, H., & Warriner, J. (2017). Nurses’ role in public health and integration of health and social care. Primary Health Care, 27(8), 20-24. http://doi.org/10.7748/phc.2017.e1294 Hansen, C. M., Kragholm, K., Pearson, D. A., Tyson, C., Monk, L., Myers, B., Nelson, D., Dupre, M. E., Fosbel, E. L., Jollis, J. G., Strauss, B., Anderson, M. L., McNally, B., & Granger, C. B. (2015). Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010-2013. JAMA, 314(3), 255-264. https://doi.org/10.1001/jama.2015.7938 General Assembly of North Carolina (Session 2011). An act to place automatic external defibrillatos (AEDS) in all buildings and facilities that house state services, agencies, and institutions and provide training for state employees in those facilities. https://www.ncleg.net/sessions/2011/bills/house/html/h914v4.html Sudden Cardiac Arrest Foundation. (2019). Portable defibrillators need regular maintenance to prevent failures. https://www.sca-aware.org/sca-news/portable-defibrillators-need-regular-maintenance-to-prevent-failures [Show Less]
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NR 506 Week 4 Assignment: Preparation of Presentation to Elected Official
Preparation of Presentation to Elected Official NR 506 Week 4 Assignment: Preparation of Presentation to Elected Official Chamberlain University College ... [Show More] of Nursing NR 506: Health Care Policy Preparation of Presentation to Elected Official Communication is a critical component to a successful working relationship with a busy government official, however Tomayko et. al. (2019) find there still remains a communication gap between legislators who make the policies, and experts who have the evidence to support policy and drive decisions . This paper will discuss an overview of a healthcare policy concern in Walkertown, NC and its solution; identify an elected official to champion the solution and the rationale for the selection of this individual; identify 4 communication/presentation techniques for staging the solution; be supported by a separately submitted video presentation; and include a self-evaluation of the video presentation. Healthcare Policy Concern and Solution The healthcare concern that I have identified in my community is the availability of an Automated External Defibrillator (AED) in public locations. Legislation in North Carolina (NC) currently only requires the presence of this life saving device in government buildings. Benjamin et. al. (2018) found that 1 out of every 7.4 people will suffer an out of hospital sudden cardiac arrest (SCA); 39.5% of these occur in a public place, 37% are witnessed; and 90% are fatal. . If an AED is present, there is opportunity for a bystander to potentially save a life. This was shown to be true by Hansen et. al. (2015) who found that after a statewide initiative to promote community based CPR and AED training, there was an increase in delivery of CPR and defibrillation from 14.1% to 23.1%; survival to hospital discharge increased from 9% to 13.9%; and survival with good neurological function increased from 7.1% to 9.7%. The evidence shows that bystander CPR in conjunction with defibrillation has a positive impact on the survival rates, recovery and health status of victims of SCA. It is my proposal that the legislation in Walkertown, NC be amended to require an AED in all public locations that can accommodate a large number of people for a period of time beyond quickly “running in”. This would include (but not be limited to) libraries, churches, schools, restaurants, gyms, shopping spaces, and both indoor and outdoor sporting venues. Identified Elected Official I have selected Mr. Wesley Hutchins, Mayor Pro Tem as the elected official to whom I plan to present my proposal. Mr. Hutchins was selected due to his experience as Dean of Emergency Services at Forsyth Technical Community College. He is skilled in relation to nonprofit organizations, budgets, operations management, and emergency management. He holds a Master of Public Administration (MPA) focusing on Disaster Preparedness and Crisis Management, and has recently retired from his position as Fire Chief of Walkertown, NC. He is a community figure known for his advocacy in the realm of human services. Communication/Presentation Techniques The techniques used to communicate with legislators should be respectful, courteous, accurate, purposeful, and time conscious (National League for Nursing, 2020). Presentations should be factual, truthful, succinct, action oriented, and show how the issue impacts constituents (Animal Welfare Institute, 2020). The goal is to make the issue important and relevant in the eyes of the legislator. One On One Verbal Communication A phone call or e-mail can be used to introduce yourself, your subject matter, and make your request. West & Corley (2016) found that e-mail was the number one choice of legislators for communicating with both constituents and their peers. My initial contact with Mr. Hutchins was via telephone call. I left a message that included my name and contact information. Mr. Hutchins responded by phone, requested an e-mail confirmation, and all our subsequent communication has been via e-mail. Face To Face Meeting West & Corley (2016) report that a face to face meeting is the clearest, least ambiguous, and most important technique for communicating with legislators. For a meeting to be successful, one must be professional, prepared, punctual, brief (but concise) and flexible (animal Welfare Institute, 2020). Effective communicators provide direct, concise information; avoid overly scientific language; provide data as opposed to opinion; and disucss issues, not political agendas (Tomayko et. al., 2019). Due to the COVID-19 social distancing requirements, I have a Skype Meeting scheduled with Mr. Hutchins. Power Point Presentation I plan to create a brief Power Point Presentation outlining the healthcare policy concern, data to support the concern, and the solution. This will also include my personal information including name, credentials, and contact information. I will send this electronically to Mr. Hutchins prior to our Skype Meeting so he can familiarize himself with the material, have a copy to follow along with during our meeting, and have a copy to keep as a reference for future use. Follow Up Letter The thank you note will invite questions, feedback, or further discussion Mr. Hutchins may have. Not only is it polite to thank someone for their time and attention, the follow up thank you note establishes you as a professional, and helps develop a collegial and collaborative relationship with the official (Tomayko et. al., 2019). The thank you note can help leave a lasting and positive impression with the official. Video Presentation Self Evaluation The video presentation was difficult due to the limited ability to visualize one’s presentation while recording using of the Kaltura program. It took several attempts to get timing and posture done correctly. It was enlightening to watch myself during a video presentation. On a positive note, I feel I introduced myself and my purpose sufficiently. The content of the presentation was logical, thorough, and supported by evidence and research. There was reference to the current legislation showing it is outdated and insufficient, data to support the need for the change in policy, there was data to support a potential for a positive impact on the community, and there was data to support the insufficiencies in the current legislation. Communication techniques were discussed and offered a variety of techniques to use in order to be thorough and effective in presentation. One area for improvement is my physical presentation. I was so nervous, and I feel it showed. It was difficult to maintain eye contact using a program that did not allow one to watch in real time. It was also difficult to make any minor adjustments to position or posture without being able to see the presentation in real time. Conclusion There is much more to a proposal than information, data, and evidence. While these components are important, effective communication and appropriate presentation are equally as important. The physical, visible engaging characteristics of the presenter help embed the evidence based, data driven information into the minds of the recipient so they are convinced the subject matter is relevant, important, and impactful in a positive manner. The presenter must be charismatic and engaging in addition to informed and knowledgable in order to catch the attention of the audience and convince them that the proposal is not only viable, but necessary. References Animal Welfare Institute, (2020). How to communicate effectively with legislators. https://awionline.org/content/how-communicate-effectively-legislators Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Chiuve, S. E., Cushman, M., Delling, F. N., Deo, R., de Ferranti, S. D., Ferguson, J. F., Fornage, M., Gillespie, C., Isasi, C. R., Jimenez, M. C., Jordan, L. C., Judd, S. E., Lackland, D., . . . Muntner, P. (2018). Heart disease and stroke statistics-2018 update: A report from the American Heart Association. Circulation, 137(12), e67-e492, http://doi.org/10.1161/CIR.0000000000000558 Hansen, C. M., Kragholm, K., Pearson, D. A., Tyson, C., Monk, L., Myers, B., Nelson, D., Dupre, M. E., Fosbel, E. L., Jollis, J. G., Strauss, B., Anderson, M. L., McNally, B., & Granger, C. B. (2015). Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010-2013. JAMA, 314(3), 255-264. https://doi.org/10.1001/jama.2015.7938 National League for Nursing, (2020). Communicating with your legislators. http://www.nln.org/docs/default-source/advocacy-public-policy/how-to-communicate-with-your-legislators-pdf.pdf?sfvrsn=2 Tomayko, E. J., Godlewski, B., Bowman, D., Settersten Jr., R. A., Weber, R. B., & Drahn, G. (2019). Leveraging public health research to inform state legislative policy that promotes health for children and families. Maternal and Child Health Journal, 23, 733-788. https://doi.org/10.1007/s10995-018-02708-x West, J. F. & Corley, E. A. (2016). An exploration of state legislator communication technology use and importance. Journal of Information Technology & Politics, 13(1), 52-71. https://dx.doi.org/10.1080/19331681.2015.1131653 [Show Less]
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NR 506: Health Care Policy Summary of Healthcare Policy Concern
NR 506: Health Care Policy Summary of Healthcare Policy Concern - power point presentation .
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NR 506 Week 2 Graded Discussion Topic: Policy-Priority Selection
NR 506 Week 2 Graded Discussion Topic: Policy-Priority Selection Identify your selected healthcare concern in your city or state that needs your advocacy ... [Show More] with an elected official. What is the impetus and rationale for your selection? What is your solution to this concern? Describe the model of policymaking that you feel would be best applied to your policy concern and the rationale for selecting this model. ANSWER The selected healthcare concern in my city that I choose to address: childhood obesity. Currently according to ‘The State of Obesity,’ Texas ranks 15th in the nation for children from ages 10-17 years old for obesity (2018). Currently, in the little rural community, I reside the local park is in bad shape and has not been updated in many years. With the amount of youth in our area that wants to use the park or parents that are concerned about the park, it would be a good outlet for getting our local children active. In the area I am in sports such as baseball, softball, football, and basketball are popular. Yet, this is another reason to update the local park to ensure that our children have a safe place to play and burn energy to help address childhood obesity. The current school of thought for childhood obesity has linked a sedentary lifestyle, demographics, diet, and genetics as serious concerns (Bhadoria et al., 2015). In my research, I found that there are many grants that can be applied to provide relief for the city budget, should they decide to choose to contribute to fighting against childhood obesity. Ideally, a small local community center that offers a gym without basic workout equipment would be better. However, considering in the recent local newspaper, the EMS services report that our small town is not paying the annual fees. The idea of a local community center with a focus on health and providing children an outlet for energy would just not be feasible. The policy model that I believe would best benefit my concern, Kingdon’s Policy Streams Model. This model consists of 3 streams: problem, policy and political stream (Mason, Gardner, Outlaw & O'Grady, 2016). My rationale for choosing this model: simplicity. The problem stream: childhood obesity; policy stream: my goal would be to combat childhood obesity at the local level. The interest groups that could be encouraged to get behind this would be parents, educators, as well as local healthcare providers. Lastly, the political stream could consist of local news media, the county health department as well as introducing grants that are created to drive the cost down and to ensure that our goals for contributing to the fight for childhood obesity. References: Bhadoria, A., Sahoo, K., Sahoo, B., Choudhury, A., Sufi, N., & Kumar, R. (2015). Childhood obesity: Causes and consequences. Journal Of Family Medicine And Primary Care, 4(2), 187. doi: 10.4103/2249-4863.154628 Mason, D., Gardner, D., Outlaw, F., & O'Grady, E. (2016). Policy & politics in nursing and health care (7th ed.). St. Louis, Missouri: Elsevier. State Briefs. (2019). Retrieved from https://www.stateofobesity.org/states/tx/ [Show Less]
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NR 506 Week 3 Graded Discussion Topic: Effective Coalition Leadership
NR 506 Week 3 Graded Discussion Topic: Effective Coalition Leadership Locate a state or national coalition advocating for your approved healthcare policy ... [Show More] concern. 1. Who are the coalition partners and is there an … leader? 2. Can you identify successes indicating strong leadership? 3. What can you add to the content for your upcoming interview from the work of this coalition? ANSWER The national coalition advocating for the approved healthcare policy concern is the Cuyahoga County Depression and Suicide Prevention Coalition under the Alcohol, Drug Addiction and Mental Health Services board of Cuyahoga County (ADAMHS). Alcohol, Drug Addiction and Mental Health Services Board in under the Ohio law that provides services such as addiction treatment, recovery services and mental health as well as coordinates public safety. The ADAMHS board is governed by several volunteer board directors who coordinates, and contracts partnered agencies to provide services that will help clients recover (“Cuyahoga County Suicide Prevention Coalition”, n.d.). Depression is one of the leading causes of disability for all ages and genders in the U.S. Approximately 121 million citizens worldwide of all genders, ages, and backgrounds are affected by depression at some point. The cases of morbidity and mortality related to depression are rising which is placing a significant amount of burden on society. In addition, depression is a very treatable disorder, but it still remains one of the most undiagnosed disorders (Moreh & O’Lawrence, 2016). The risk factors associated with this disorder include gender, psychosocial and family environment, or genetic disposition. Considering the facts surrounding depression, it will be crucial as a future Family Nurse Practitioner to be able to understand, diagnose, and treat this disorder promptly. The coalition partners include Cuyahoga county institutes, they provide CEU’s and training that will help improve lives through wellness, recovery and independence. Progressive field is partnered with this coalition, by purchasing game ticket the ADAMHS board will receive a $2 donation this is to help improve awareness on mental health issues. Also, 24-Hour Suicide Prevention/Mental Health & Addiction Crisis Services partnered with ADAMHS board the serves the Cuyahoga county by providing suicide postvention response team, they are volunteer who provide immediate assistance to affected family by suicide. ADAMHS is also partnered with a free online behavioral health screening, provides information on Opioid/Heroin Addiction and help. Another partner of this board is recovery is beautiful which provides a 5-year transition to recovery program in Ohio. Other larger partner agencies are the Ohio Department of Mental Health (ODMH), Ohio Department of Alcohol and Drug Addiction Services (ODADAS), Transitional Age Community Treatment (TACT). The identified leader is Rev. Benjamin F. Gohlstin, Sr., who is the Chair member of ADAMHS board. Rev. Gohlstin Sr is the C.E.O. of Ministerial Board Chairperson Crisis Center and a Pastor of Heritage Institutional Baptist Church, he is also the Board President of Hunger Network of Greater Cleveland. In addition, effective July 1, 2018 he was elected as the Board Chair member of ADAMHS (“Cuyahoga County Suicide Prevention Coalition”, n.d.). One success that indicates strong leadership of ADAMHS board members is the unlimited support in keeping the public safety and making sure that they are meeting the purpose in helping the people. ADAMHS supports one of the hospital’s project DAWN (Death Avoided with Naloxone): Naloxone Saves lives in the Cleveland area by giving a grant of $100,00 towards the hospitals project. This grant, it will allow the hospital to buy extra 2000 more naloxone kits that will help saves life from drug overdose (“Cuyahoga County Suicide Prevention Coalition”, n.d.). Although this coalition provides services to all the people, I notice that their services are generalized, meaning there is no specific target age group. Therefor, one content that I would like to add on the upcoming interview is to examine the area where we can improve to decrease mortality rate in teens/youth in the state of Ohio and grant a funding to help the addition and utilization of advance nurse practitioners within the school system to help assess and treat depression to prevent suicide among students. References Cuyahoga county suicide prevention coalition. (n.d.). Alcohol, Drug Addiction & Mental Health Services (ADAMHS) Board of Cuyahoga County Web Site. Retrieved from http://adamhscc.org/en-US/Suicide-Prevention-Help.aspx Moreh, S., & O’Lawrence, H., (2016). Common risk factors associated with adolescent and young adult depression. Journal Of Health & Human Services Administration, 39, 283-310. Student Response Hello Nicole, Great discussion and great topic this week. It is very sad that there are many American who are homeless in this country. The chronic homelessness in America is one of the national issues that is a challenge to eradicate. Many homeless Americans lived in big cities such as California and New York City. Between 2008 of October and 2009 of September there were about 1.7 million American people used a transitional housing program. According to Padgett, Henwood, & Tsemberis (2015), the number of homeless American’s increased in the 1980’s due to increase in housing cost and increase cuts on social services and during great recession. “After many years of advocacy and numerous revisions, President Ronald Raegan signed into law the McKinney–Vento Homeless Assistance Act in 1987; this remains the only piece of federal legislation that allocates funding to the direct service of homeless people. Over the past decades, the availability and quality of data on homelessness has improved considerably” (Padgett et al., 2015, para. 9). According to Padgett et al. (2015) the most common cause of homelessness here in America is the lack of affordable housing, poverty, mental illness, gambling, natural disaster that destroys houses (hurricane or earthquake) and lack of government services. Currently we have several services that can assist homeless people in America including federal legislation (homeless bill of rights), improved health care access, affordable housing and non-profit effort such as your identified coalition. I hope that your identified national coalition for the homeless continue to support and fight for the voiceless homeless Americans. Thank you, Kind Regards, Restituto. Reference Padgett, D. K., Henwood, B. F., & Tsemberis, S. J. (2015). Homelessness in America. Housing First, 16-29. doi:10.1093/acprof:oso/9780199989805.003.0002 Instructor Response Penny, do you think that a coalition must have a leader? Hello Dr MJ, I would also like to answer your question to Penny- “do you think that a coalition must have a leader?”. I think you brought up a simple question yet provides an important assessment of the understanding of the coalition and the functions of a leader. I think that the structure of an organization varies and how it operates. Although for the purpose of a strong structure of an organization or coalition I think that it is important to have a strong leader that has the quality to manage the organization or coalition to move forward in meeting the coalitions objectives as well as their missions. Having a leader in an organization or coalition is very beneficial as well as vital to the organizations success thus promoting success to the community. Without a leader, the coalition will be operating only as one system rather than a partnership with the community. The function of a leader is towards leadership and growth of the organization or coalition and most importantly success for the people that this coalition are serving. In addition, leaders are the forefront in bringing the people together to work as one to provide help to the communities need. Furthermore, one important quality of a leader is being trustworthy. It is crucial as a leadership that you show trust to your organization and the people you work for. Because, trust is part of leadership, meaning it is important to create a positive relationship or connections to build a strong coalition or organization. Kind regards, Tuto [Show Less]
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NR 506 Week 5 Graded Discussion Topic: Drivers for High Performance Healthcare
NR 506 Week 5 Graded Discussion Topic: Drivers for High Performance Healthcare Select two drivers (for example quality, cost, and access) of high perfor... [Show More] mance healthcare systems and apply it to your current work situation. The application could demonstrate the presence of the driver in a positive manner or it could acknowledge the presence of a concern. ANSWER In this country, health care reform continues to grow, but we have seen confusion about what high performance healthcare system composed of. Because of innovation in healthcare quality and advancing high performance in healthcare, American Medical Group Association (AMGA) took the stand to be the leader to educate legislators, public and issuers regarding the unique qualities of this system and to help healthcare organizations to improve their patient care (Wylie, Crilly, Toloo, Fitzgerald, Burke, Williams & Bell, 2015). According to Wylie et al., (2015), high-performing healthcare system is defined as an entity that provides efficient provision of services, organized system of care, Quality Measurement and Improvement Activities, Care Coordination, Use of Information Technology and Evidence-based Medicine, and Accountability. I think that quality and cost are relatively two very important drivers that could affect the high-performance healthcare system, which are present in my current workplace. For instance, Shortage in nursing have been a talk and an ongoing issue that is seen in the last decade within the nursing profession. It seems that in my nursing department, we constantly experience short staffing from time to time (not cost effective because we tend to use agency nurses which are paid higher than regular staff). Often, I would, or other coworkers would come in just to help out because of short staffing (over time, which is another budget issue). Because of this costly staffing issue, the management became tighter on nurse patient ratio leading to unsafe patient care, staff burned out, decrease patient satisfaction and decrease employees job satisfaction (causing them to leave their job). I honestly often experience short staffing since I started working as a Rehab Registered Nurse (RN), it is difficult because of increased nurse patient ratio. Having increased patient ratio leads to poor quality of patient care which leads to poor patient outcomes (Morrison, 2014). According to Wylie et al., (2015), the survey showed ten (10) percent do not believe that health care organization cost-containment negatively affects the quality of care, while eighty (80) percent believe that the cost-containment negatively affects the patient quality of care. This survey was conducted in one of hospital’s medical surgical floor in Australia. This article relates to my current workplace, it seems that the focus of my department is all about the number of patient and not the actual patient care while the organization or the management continue to expect excellent customer service. It is expected by the management to provide high quality of care even with short staffing or inappropriate nurse patient ratio due to organizations cost-containment practice. I believe that if issue such as high nurse patient ratio and short staffing continued it will lead to patient harm which may lead to patient’s death. Therefore, every employer needs to assess the issue of short staffing and their cost-containment practice to develop an action plan to stop the unsafe staffing and nurse patient ratio within my current work place. According to Morrison (2014) appropriate nurse patient ratio promotes safe and high quality of patient care. Reference Morrison, G. (2014). Cost containment project - Final report. Journal For Healthcare Quality, 7(3), 15. doi:10.1097/01445442-198507000-00014 Wylie, K., Crilly, J., Toloo, G., Fitzgerald, G., Burke, J., Williams, G., & Bell, A. (2015). Review article: Emergency department models of care in the context of care quality and cost: A systematic review. Emergency Medicine Australasia, 27(2), 95-101. http://dx.doi.org/10:1111/1742-6732.12367 Instructor response Stephanie - I really wonder why upper level hospital management is not cognizant of the impact of heavy work loads on personnel morale at the unit level. You would think that they would know/be aware of the impact, but it seems in facility after facility this same issue persists and no one does anything about it. What could be some reasons for ignoring this issue? Hello Dr MJ, Thank you for sharing your input on Stephanie’s discussion this week, I would also like to answer your question towards Stephanie. The heavy workload of nurses is one of many problems in our healthcare system today. According to Weiss (2018), nurses experiences increased workload due to several reasons such as reduced staffing and increased overtime, in adequate supply of nurses, as well as increased demand for nurses. In my experience, we have nursing staff high turnover rate because of low pay rate and heavy work load (when I say heavy work load, its high acuity and high patient ratio). This is one of the reasons why my nursing department cannot keep up with very low staff retention rate. There have been so many suggestions what to do to improve staff retention but none of the hospital corporate listens, they are more worried about their budget rather than the safety of their staff and their patient. As I mentioned in my discussion, it seems that in my nursing department, we constantly experience short staffing from time to time (not cost effective because we tend to use agency nurses which are paid higher than regular staff). Often, I would, or other coworkers would come in just to help out because of short staffing (over time, which is another budget issue). Because of this costly staffing issue, the management became tighter on nurse patient ratio leading to unsafe patient care, staff burned out, decrease patient satisfaction and decrease employees job satisfaction (causing them to leave their job). I honestly often experience short staffing since I started working as a Rehab Registered Nurse (RN), it is difficult because of increased nurse patient ratio. Having increased patient ratio leads to poor quality of patient care which leads to poor patient outcomes (Morrison, 2014). I don’t think that the upper manage ignores our suggestions and the impact of unsafe staffing, I believe it is being influenced by the rules created by hospital corporate that needs to be followed. I found that our nursing management submits all the issues and concerns along with solutions to the hospital corporate, but it only ends up unheard because it does not “meet” the corporate rules. For example, our supervisor follows staffing ratio based on the number of patients created by our hospital corporate (note: some of this people who created these rules are business expert not experienced healthcare worker), did I mention acuity? I did not because our corporate does not care about acuity. This is why a lot of our nursing staff left the job because of unsafe and high acuity patient ratio which is detrimental to patient and the caregivers. Therefore, I conclude that the corporate does not care how heavy the workload of the staff is because they only see the patient as a number not the actual severity of patient’s health issue. According to Weiss (2018), hospital corporation is all about how much profit they will make and does not really care about their stakeholders nor staff. Often, this is how I feel at my workplace, I love my patient, but it seems like the organizations does not care about the patient and us. Reference Weiss, L. D. (2018). Alternative health care industry. Private Medicine and Public Health, 9(3), 95-108. doi:10.4324/9780429498039-7 Hello Stephanie, Your point is spot on, I totally agree with you that most hospital have a budget to maintain. In fact, last year our hospital cut our annual raise from 3% to 2% percent because we didn’t meet the budget for that previous year because apparently, we used “too much” staff when we were low census (meaning they lost profit that previous year). Often, they don’t use agency nurses or nursing tech’s when we are short staff because agency gets paid more. When you pick up extra hours to help out, you will be the number one to get cancelled on the following week. Our staffing is ridiculous to the point that it is not safe at all because according to the staffing rubric created by hospital corporate it doesn’t matter what the patient acuity, they will not care how bad it is having eight (8) with a high acuity patient as long as all the patient are covered. Recently, we have been having one nursing assistant on one floor with sixteen (16) patient (of course high acuity and mostly max of 2 assists), so one of my dilemma was we aren’t allowed to answer the call light using the telephone at the nurses station, the management wants us to physically go in to check what the patient needs, For instance, a patient at the very end of the hall way rang the bell, I would answer using the telephone at the nurses station and ask what they need, instead of walking all the way to the end of the hall when all they need is a cup of water. So, the management wants us the follow their rules that often does not make sense and not appropriate for short staff. So, I advocated for all the staff to allow us to answer the call lights using the telephone that is by the nursing station. Guess what I got denied because they want us to properly provide good customer service. It is ridiculous that we are working so hard and not even give us a fair solution. Regards, Tuto [Show Less]
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NR 506 Week 1 Graded Discussion Topic: The Four Spheres of Political Action in Nursing.
NR 506 Week 1 Graded Discussion Topic: The Four Spheres of Political Action in Nursing. Please discuss the four spheres of political action in nursing. ... [Show More] In addition, please develop a brief argument sharing how these spheres are interconnected and overlapping by applying an example from your practice. What are some ethical considerations here? ANSWER The four spheres of political action in nursing are the workplace, government, associations and interest groups, and the community (Mason, Gardner, Outlaw, & O'Grady, 2016). Nurses have the ability to affect change in those four areas (Mason et al., 2016). While each of these spheres exists in its own right, they are interconnected on many levels (Mason et al., 2016). What nurses do in the workplace is directed by regulations that are set in place on governmental levels. Special interest groups and the communities in which nurses serve directly affect how the hospitals care for the patients. Nurses make up one in four voters and have the knowledge and expertise to shape legislation to advocate for their patients (Phillips, 2012). I work at a magnet hospital and one of the tenants of magnet is shared governance (Clavelle, O'Grady, & Drenkard, 2013). Through shared governance, nurses are empowered to change the organization to better care for their patients (Clavelle et al., 2013). By getting the staff actively involved in the organization they have the feeling of control, which allows them to bring ideas to the table and be heard (Clavelle et al., 2013). Smoking in the workplace is a public health risk. The Cleveland Clinic has enacted a no smoking policy for its employees through working with shared governance, various levels of employees, management, insurance companies and other organizations. If you belong to the Cleveland Clinic health insurance, in order to receive a discount on your insurance, you have to wear a pedometer and meet a certain number of steps each month. This is to combat the public health epidemic of obesity. The organization is trying to encourage activity in its staff which will help us better serve the community. Ethical considerations of the four spheres and the interconnection is obviously corruption or making decisions for the benefit of one and not the many. If interest groups have too much sway with the government, they will be able to legislate issues that are may be harmful to the community. References Clavelle, J., O'Grady, T., & Drenkard, K. (2013). Structural empowerment and the nursing practice environment in Magnet (R) organizations. Journal of Nursing Administration, 43(11), 566-573. Mason, D. J., Gardner, D. B., Outlaw, F. H., & O'Grady, E. T. (Eds). (2016). Policy & politics in nursing and healthcare (7th ed.). Retrieved from https://bookshelf.vitalsource.com Phillips, C. D. (2012). Emergency nursing advocacy: Nurses becoming political advocates. Journal of Emergency Nursing, 38, 470-471. doi:10.1016/j.jen.2012.05.022 ameka, Thank you for your post! I especially liked your explanation of nurse to patient ratios and how the political climate has influenced this. Should not the institution hire more caregivers if they are making more money?? Just saying...... Dr. Stiller: Nurse to patient ratios is another way in which nurses can show their collective legislative power. Campaigning on a patient safety platform, California was able to mandate patient ratios of four patients or less to every one registered nurse depending on the unit acuity (Strachan-Hall, 2017). When this mandate was passed, there was a concern about having enough funding for this number of nurses and being able to recruit the right number, but these fears were not realized (Strachan-Hall, 2017). Here in Ohio, there is no such mandate. Luckily, I work at a main campus and during the day on my stepdown unit we rarely have greater than a four to one ration, sometimes it is five to one. At night however, it can be five to six to one. The Cleveland Clinic is the number one heart center in the country. We care for the sickest of the sick, and the post-operative patients we see on my floor are often 24 hours out of open heart surgery. We also care for LVAD and total artificial heart patients. Our patients on stepdown are easily ICU patients in other hospitals. I say this not to brag, but to say it is difficult to recruit, train and maintain experienced nurses. Nurses become overworked and fatigued quickly in this environment. It is difficult to stay motivated when you feel you’re not able to care for your patients thoroughly because you do not have time. This is where nurses should advocate not just for their patients but for themselves as well. If we used the special interest groups and tried to lobby our states for mandates, perhaps we would have a happier, healthier workforce. California has seen up to a two percent drop in staff sicknesses and a drop in turnover (Strachan-Hall, 2017). This leads to better outcomes for the patients (Strachan-Hall, 2017). While it seems like it would cost the hospitals more to hire additional nurses, it would actually save them money because it would lower turnover and training costs (Strachan-Hall, 2017). It is easier and less expensive to keep the skilled nurses you have than to hire new nurses each year. Reference Strachan-Hall, E. (2017). California has won case for nurse-patient ratios. Nursing Management - UK, 23(9), 15. Look at your responses on the threaded discussion this week to ensure that you answer the question this week completely. Some of you outlined theory but did not apply it to a specific example. Also there was a question regarding ethics. We all know that there are times when there are ethical considerations that are being "glossed over" and not fully considered either by the organizations that we work for or by one of the other drivers. If you did not hit upon these ethical considerations in your example please elaborate now. Also I took it easy on everybody this first week and did not ask many questions. I am sorry. I forgot you need a question from me to elaborate on for your second post. If you simply created a post #2 in response to your peers comments or questions this first week that is OK. In your example which driver do you think might be having the greatest influence and why? What factors do you think are contributing to this? Best wishes as you finish out week #1 and start preparing week #2! Sincerely, Dr. Cate Stiller Rebekah Rogers 2/28/2017 9:30:39 PM Week 1 TD Nursing as a profession has the capability, power, and resources to become politically active in promoting optimal public health, reducing health care costs, improving safe, quality, and evidence-based nursing care, and advocating for nurse managed community services for vulnerable and under-served populations (Woodward, Smart, & Benavides-Vaello, 2016). Government, workplace, professional organizations, and the community encompass the four spheres of political action in nursing (Mason, Gardner, Outlaw, & O'Grady, 2016). Although each sphere has its own independent function, each domain is an element of a more global and multifaceted system where change or action in one sphere often influences and stimulates change in other spheres. Government plays a substantial role in influencing and determining scope of nursing practice, eligibility for individuals to receive healthcare programs, reimbursement of healthcare dollars, and shaping policy to address health and social problems (Mason et al., 2016). Nurses’ work in a variety of different settings where resources are limited and policies guide many activities affecting staffing ratios, clinical procedures, and patient care. State laws also regulate nursing licensure, immunizations, and certifications (Mason et al., 2016). Professional nursing associations advocate for policies that support their concerns, promote political involvement, and enhance networking (Woodward et al., 2016). Identifying problems, advocating for change, organizing support, and serving on planning boards are approaches nurses can take to be influential in the community (Mason et al., 2016). I currently work in a hospital where an accrediting organization, The Joint Commission, cited the facility a few years back for allowing nurses to “practice medicine without a license” based on nurses selecting a dose of an opioid medication from a range order for pain management based on a comprehensive pain assessment. The recommendation by the surveyors was for physician orders written with a specific opioid dose dependent on a specific pain intensity rating. As a result of this action, pain management policies and opioid medications orders were changed to reflect a dose based on a number leading to adverse patient outcomes including excessive sedation and respiratory depression as a result of overmedication. I participated in a pain task force to review and collect data related to the increase of Naloxone use and rapid response calls related to dosing opioids to a pain score. As a member of the American Society for Pain Management Nursing (ASPMN), this issue was also extensively discussed at national pain conferences and a hot topic on our pain list serve. This resulted in ASPMN writing a position statement advocating for prohibiting prescribing and administering opioid doses based solely on pain intensity numbers. Policy choices ultimately bring a significant loss to some groups while others benefit (Mason et al., 2016). Ethical considerations and care of patients is based on values and guided by professional code of ethics and principles including beneficence, non-maleficence, autonomy, and justice (Woodward et al., 2016). Ethical challenges associated with goals of care related to relieving pain and suffering with opioid analgesics, may lead to issues surrounding assessment, treatment, education, and control of pain. References Mason, D. J., Gardner, D. B., Outlaw, F. H., & O'Grady, E. T. (2016). Policy & politics in nursing and healthcare (7th ed.). Retrieved from http://online.vitalsource.com Woodward, B., Smart, D., & Benavides-Vaello. (2016). Modifiable factors that support political participation by nurses. Journal of Professional Nursing, 32(1), 54-61. doi: 10.1016/j.profnurs.2015.06.005 Rebekah: My hospital has had the same issues with pain medications that you have seen. We are all under the joint commission and in addition we are a magnet hospital. The ways we respond to orders are part of our magnet status (Clavelle, O'Grady, & Drenkard, 2013). Our physicians and nurse practitioners write orders for pain management in specific pain score ranges. In general, Oxycodone for severe pain 7-10, Ultram for moderate 4-6, acetaminophen 1-3. Often the Ultram will be written for breakthrough pain. If I have a patient that may be wary of opiods and wishes to take the Ultram, I must first administer oxycodone or acetaminophen or I am practicing out of my scope of practice. The pain rating scale is also extremely subjective. A 2 for my may be someone else’s 6, or any combination. Working with patients just hours and days out of open heart surgery, the pain can vary from person to person. Perhaps they know that one oxycodone helps relieve their pain and allows them to walk 3-5 times a day, do their hourly breathing treatments and be comfortable. When I am administering the medication, we know it is not suppressing their respiratory drive and they mention their pain score is only a 5. I have to either not give the medication they need or document that the pain score is a 7 or higher to be within my scope of practice. Without going on too much, nurses at my hospital do not have the ability to just nursing judgement. All patients are ordered a stool softener and laxative BID post-surgery. If I have a patient that is having liquid stools, I cannot hold the medication without notifying the doctor via a page, writing a note and educating the patient. These policies and procedures stem from governmental and special interest rules and regulations (Clavelle et al., 2013). Think about the ethical situations the pain score scenario puts nurses in. While we are not licensed to practice medicine, we have the ability to judge whether or not we should give a pain medication to an ambulating patient that is stable. I like that there is an organization lobbying against the simple order of pain score to medication ratio. The situation is more complex than that. As nurses, we can educate our patients about the safety of certain medication and advocate for the proper short term use. I tell my patients that while you do not want to take them forever, the do help in the short term to get you better. There is a great opioid crisis right now. A small part of this is the way medical professionals view and prescribe them in addition to the way they are taken. Reference Clavelle, J., O'Grady, T., & Drenkard, K. (2013). Structural empowerment and the nursing practice environment in Magnet (R) organizations. Journal of Nursing Administration, 43(11), 566-573. [Show Less]
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NR 506 Week 7 Graded Discussion Topic: RN as Healthcare Policy Leader
NR 506 Week 7 Graded Discussion Topic: RN as Healthcare Policy Leader As a health policy professional leader, communicating with lay audiences is an imp... [Show More] ortant skill in promoting the health of the community for master prepared registered nurses. Develop a concise position statement reflecting the research findings and recommendations by experts as they relate to medical marijuana services in the community. ANSWER A position statement is an organization, company or persons statement on a specific subject. As an advanced practice nurse and a leader in the field, I will need to develop several stances on subjects as they affect my patients and practice. From the list provided in this week’s question, I want to discuss the use of medical marijuana services in the community. Part of a position statement is justifying one’s position with evidence. Marijuana is currently a Schedule I controlled substance so the study of the uses of the drug are constrained (Whiting et al., 2015). However, medical marijuana is currently legal in other countries and in 23 states in the US (Whiting et al., 2015). Several diseases like chronic pain, glaucoma, and spasticity have been proven to show relief of signs and symptoms of the disease with the use of medical marijuana (Whiting et al., 2015). Whiting et al. (2015) conducted a systematic review of 79 articles, a level I study, the highest in the level of evidence pyramid. While the results did not reach statistical significance in all of the 79 randomized control trials, most showed improvement in symptoms with the use of medical marijuana, with minimal but some adverse effects (Whiting et al., 2015). As a future Family Nurse Practitioner, I will be treating patients with many of the ailments that can be helped by this drug. In making my decision, I looked to what the position of the American Nurses Association (ANA) is. The ANA recognizes the potential benefit of medical marijuana and would like to see the government reclassify the rating of controlled substance to allow for more and better research on the subject (Nursing World, 2016). As my patients advocate, I think it behooves the us to use all of the tools we have. If this medication can alleviate symptoms and bring relief to patients we should do it. With the opioid epidemic plaguing the nation right now, the use of something with minimal to no adverse effects is something that should at the very least be researched. I plan on practicing in Ohio, and the initiative for medical marijuana passed in 2016. Currently no dispensaries are open, but by the time I graduate they will be. This is something I will be following to see how it will affect my practice. References Nursing World. (2016). Therapeutic use of marijuana and related cannabinoids. Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/ANAPositionStatements/Position-Statements-Alphabetically/Therapeutic-Use-of-Marijuana-and-Related-Cannabinoids.pdf Whiting, P. F., Wolff, R. F., Deshpande, S., Di Nisio, M., Duffy, S., Hernandez, A. V., Keurentjes, K., Lang, S., Misso, K., Ryder, S., Schmidlkofer, S., Westwood, M., Kleijnen, J. (2015). Cannabinoids for medical use: A systematic review and meta-analysis. Jama, 313(24), 2456-2473. doi:10.1001/jama.2015.6358 Hi Christy: Great post. I was going to write about this subject myself, but went a different direction. Breastfeeding in today’s society is so incredibly hard on top of the natural barriers and obstacles many women may face. I had a beautiful baby boy in February 2016 and breastfeeding was terribly difficult for us. I had a planned c-section due to his transverse lie, then he was born with tongue tie. I also was shaking so badly from the spinal that I was not able to hold him for a while after birth so we missed that golden hour. More and more things happened and we ended up having to supplement. He was not able to latch even though we corrected the tongue tie. About a month in of exclusive pumping, I developed my first round of mastitis and the antibiotics I had to take gave him thrush. This was followed by two more rounds of mastitis. During this whole time, I had post-partum depression and anxiety and crippling guilt about not being able to feed my baby because “breast is best.” Finally, about 8 weeks in I had to decide that he needed a healthy mother who wasn’t driving herself crazy trying to breastfeed. This is one of the hardest things I have ever had to do. This decision still plagues me and makes the subject of breast feeding near and dear to me. It is hard enough to do and to possibly have to give up because one cannot do what they need to at work is awful. Many employers offer breast feeding rooms and say that the mother can take the time, but in reality, that doesn’t always happen. Take my hospital for example. The breast-feeding rooms are few and usually far from the unit. In addition, they are locked, so you have to obtain the key or find someone to let you in. Management says they support the mom’s but finding 15-20 minutes two or three times a shift to go pump is next to impossible with the acuity of our patients and staffing. Much can and should be done to improve this for working mothers. As future advanced practice nurses, some of whom may work in women’s health, this is a great cause to lobby for and try to correct. I don’t know what I would have done if I had returned to work with all my complications and been forced to stop or lost production due to lack of resources. Christy Sambolin 4/11/2017 6:27:45 PM RN as Healthcare Policy Leader Professor and class, This subject is close to my heart for personal reasons. Mother’s breastfeeding their babies is a convenience to the community. Working to reduce workplace hurdles to breastfeeding will help to increase breastfeeding rates and the duration of breastfeeding, which will help to improve the health of mother, baby, and the community as a whole. Breast feeding infants is a natural process with many benefits to both mother and baby, which then lends ease to employers as well (Cabrera & Smith, 2016). Breast milk is the healthiest choice for feeding babies and sole breastfeeding of babies is proposed until 6 months of age with ongoing breastfeeding until two years old (Cabrera & Smith, 2016). The advantage that affect employers as an outcome of babies being breastfed are reduced frequent absences from work due to healthier mom and baby, decreased costs for healthcare and insurance because of mom and baby being healthier, and higher rates of employee retention related to higher morale (Cabrera & Smith, 2016). Even with the proof showing the many benefits to be gained by mothers, babies, and even employers; breastfeeding rates remain less than choice. Studies showed that in the United States in 2011 only 79% of mothers breastfed their babies originally after birth with only 49% of mothers still continuing to breastfed at 6 months and only 27% still breast feeding at 1 year (Cabrera & Smith, 2016). Even though the welfare of mothers still run into many roadblocks to breastfeeding when returning to work. Some of these barriers include employer’s lack of knowledge about breastfeeding, lack of support from staff and supervisors from the lack of knowledge, obstinate hours, lack of satisfactory areas to pump milk to include clean well lit areas with outlets and a means to store the pumped milk, and necessary time granted to pump milk at work (Cabrera & Smith, 2016). Christy Reference Cabrera, G., & Smith, N. (2016). Breastfeeding: Working Mothers (United States). CINAHL Nursing Guide. Instructor STILLERreply to Susan Franklin 4/13/2017 7:10:23 PM RE: RN policy leader Susan, Thank you for discussing this very important issue. I am passionate about educating nurses on end of life care. I have one graduate student who is choosing to work on educating the nurses on her OB unit on handling the delicate and sad situation of babies who are born lifeless. How does one approach the parents regarding this event? I have seen poorer care given by nurses who are new to the field and who have no experience with this type of client. I am attending an ELNEC (End of Life Nursing Education Consortium) training in Savannah, Georgia on the 24th for Core Training on End of Life Care for educators. I hope to bring this information back and teach all of the nurses I can find! I have done this before and couldn't get anyone to host this type of education. Wish me better luck this time! Dr. Cate Stiller Dr. Stiller: I cannot imagine how to deal with infant loss and parents. As a RN that works in a post-operative setting, we are focused on maintaining and improving life. My unit has 24 private rooms. A few times a year we receive hospice patients where end of life is eminent. I feel very unprepared to care for them. The conflict inside me to want to do things rages when we do not have to take vital signs or monitor them on telemetry. I wish I had a few more tools in my toolbox for this. A few weeks ago, I went into work and received report on a patient. He was a newly diagnosed with multiple myeloma and was suffering with cardiac amyloidosis among many other signs and symptoms. His journey had been short, over the last month or so be became more and more ill and was in the hospital receiving swan therapy, not knowing what was happening to his body. The diagnosis was delivered the day before I assumed care for him. I worked three of the next four days. Saturday and Sunday were days of gaining more information and gaining a clearer picture of what was going happening. There was no less than ten people in the room at any time both days. I spent much of this caring for his edematous and weeping lower extremities, monitoring him and trying to lift their spirits. I wanted him to know that we were going to do everything we could and I would let them know anything as soon as I found it out. I was going to be off on Monday. The patient and the family were to get the plan of care and the rest of the picture when the cardiologists and oncologists met with them Monday morning. They begged me to pick up a day, they wanted me with them since they knew the news would be difficult. Unfortunately, I was unable to pick up the day. Tuesday when I came in, I received my update report and it was a whole new world. The patient and family decided that they did not want to pursue treatment and would be going home that day or the next with hospice. He did not want to be in the hospital any longer and the choice was to pursue quality over quantity. I had grown fond of him and this hit me hard. I know it is his choice and I cannot assume or imagine what I would choose if in that situation. I felt awkward and numb and at a loss for what to say. That day we did not have to monitor him, take vitals, monitor I&O’s or do any of the standard things. I had a long conversation with the hospice nurse who came to help set the family up with all of the equipment and things they would need at home. What she does is the opposite of my job, but still as valuable a service to the patients. We all learn about death and dying, and it is as much a part of life as birth. It seems like such a foreign concept to me. Most people prefer to die at home (Ellershaw, O'Brien, & Murphy, 2017). More often than not though, it happens in the hospital (Ellershaw, O'Brien, & Murphy, 2017). I think that nurses like myself should be versed a little more in death as well as life. I know that when completing my continuing education credits for my RN renewal, I’m going to look into a few classes to get new tools. Reference Ellershaw, J., O'Brien, B., & Murphy, D. (2017). Breaking new ground in hospital palliative and end-of-life care: Liverpool's academic palliative care unit. European Journal of Palliative Care, 24(1), 36-41. [Show Less]
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