Identification of Healthcare Policy Concern
NR 506 Week 2 Assignment: Identification of Healthcare Policy Concern
Chamberlain University College of
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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]