NR 506 Healthcare Policy ,100% CORRECT

NR 506 Healthcare Policy Week 1, TD1 The Four Spheres of Political Action in Nursing. Please discuss the four spheres of political action in nursing. In addition, please develop a brief argument sharing how these s ...

NR 506 Healthcare Policy Week 1, TD1 The Four Spheres of Political Action in Nursing. Please discuss the four spheres of political action in nursing. In addition, please develop a brief argument sharing how these spheres are interconnected and overlapping by applying an example from your practice. Nursing should not consist of only the monotonous tasks completed to provide basic patient care, but rather nursing today is multidimensional where nurses are responsible for the protection, promotion, and prevention of disease or injury for individuals, families, communities, and population. For this reason, nurses have the opportunity to become politically involved impacting and improving the level of care that they are able to provide. According to Chaffee, Mason, & Leavitt (2014), the four spheres of political action in nursing include workplace or workforce, government, professional organization, and community. Each of these sphere have their own independent functions, but they can also overlap and affect the other sphere working together to create changes. Workplace sphere addresses issues regarding jobs and patient care, as well as influencing policies and procedures. It can be in any setting like acute care, home care, nursing homes, school based clinics, occupational health clinics, and physician’s office. Government sphere addresses laws and regulations regarding practice, as well as influencing local, state, and national policies. Government actions can consists of laws requiring to keep birth records, immunizations, legal establishment of drinking age, laws determining what health services people are eligible for at certain age. Government has grown bigger and centralized, which plays a important role in nursing. Government also influences systems for healthcare, and nursing service, and determines who receives what type of health services. Professional organizations sphere addresses the many areas that shape the practice of nursing, as well as influence practice standards, and credentialing. Professional organizations should be a visible force within its community, and must have a national presence. Professional organizations take a leadership role on calling for the development of policies that can improve the health of the communities, and ensure the provision of quality nursing care. Community sphere addresses issues regarding community health as well as influencing the activity throughout the community. Community includes special interest organizations like habitat for humanity, food banks, community organizations, and county workforce centers. Nurses have the responsibility to promote the welfare of the community, and its members. Nurses visible in the community represent the entire profession. Nurses are capable of influencing policy making in order to improve problems in the community and healthcare system. Literature often shows that nurses view themselves as politically powerless. They see their role at the bedside as a technical activity, not a political opportunity. What nurses do not realize is the very act of being a nurse makes one politically involved (Cameron, Ceci, & Salas, 2011). An example from my practice is banned smoking at the campus of my hospital, which is a community hospital. Political spheres includes the workplace and community, possibly government with the federally mandated health insurance laws rolling out. This is important as the negative effects of smoking and second hand smoke are well documented, and patients requiring hospitalized care do not need to be exposed. Reference: Cameron, B., Ceci, C., & Salas, A. S. (2011). Nursing and the Political. Nursing Philosophy, 12(3), 153-155. doi:10.1111/j.1466-769X.2011.00499.x. Chaffee, M. W., Mason, D. J., & Leavitt, J. K. (2014). A Framework for Action in Policy and Politics. Policy & Politics in Nursing and Health Care, 1. Week 1, TD2 A wave of pandemic illness can host a variety of ethical considerations. Please apply the importance of ethics to the process of policymaking regarding pandemic outbreak and other future pandemic issues. Ethical consideration during a wave of pandemic illness involves critical reflection on moral or ethical problems faced in health care setting. It is a collective forethought and a broad consensus in place to tackle moral and ethical dilemmas that may arise in situation of a pandemic illness. According to Cooper (2012), there are many ways to define ethics, some are more technical and precise than others. Ethics can be defined as the attempt to state and evaluate principles by which ethical problems may be solved (Cooper, 2012). Government and health care leaders make decision based on the ethical values in case of a catastrophe. Ethical framework acts as a guide in decision making during a pandemic by guiding the ethical decision making process, and informed by ethical values. The topic of ethics comes up whenever there is pandemic illness outbreak. Some of the ethical issues of concerns regarding pandemic illness include healthcare workers being exposed to illness, prohibiting travel to prevent spread of illness, and access to healthcare with an increase in demand and potential shortage of healthcare workers. In the event of a pandemic a pandemic illness the Centers of Disease Control and Prevention (CDC) has worked with the Ethics Subcommittee of the advisory committee to develop a plan of care. Professional colleges and associations should provide, by way of their codes of ethics, clear guidance to members in advance of a major communicable disease outbreak, such as pandemic flu. Existing mechanisms should be identified, or means should be developed, to inform college members as to expectations and obligations regarding the duty to provide care during a communicable disease outbreak. In a study on influenza pandemic by Devani, M., Gupta, & Devani, B.(2011), there were three main ethical consideration for planning and response: ethical allocation of scarce resources, obligations and duties of healthcare workers to treat patients, and the balance between conflicting individual and community interests. Most challenging part was identified as how to allocate scarce life saving resources in case of a pandemic (Devani et al., 2011). Indication of clear goal for possible future pandemics is essential in making difficult choices (Devani et al., 2011). Also the important issues between duty to save the patients and protecting own life were also identified as a key issue (Devani et al., 2011). This study also threw light on how to strike balance between civil liberties and individual freedom (Devani et al., 2011). Pandemic planning for current and future outbreaks should be a cooperative and shared responsibility that balances community and individual interests (Devani et al., 2011). References: Cooper, T. L. (2012). The responsible administrator: An approach to ethics for the administrative role. John Wiley & Sons. Devnani, M., Gupta, A. K., & Devnani, B. (2011). Planning and response to influenza A (H1N1) pandemic: ethics, equity and justice. Indian J Med Ethics, 8(4), 237-240. Peer response TD, WEEK 1 It can be acknowledge easily that all nurses particularly advanced practice nurses (APNs) are touched by policy and politics of health care system and the impact of policies, legislation, and regulations developed in those arenas have on the way they practice their profession. According to Matthews (2012), goals of political advocacy involves better nurse involvement in delivering access to care, influencing the coast and quality of care, determining the scope and authority of practice, and increasing and improving the healthcare workforce. As the healthcare system continues to evolve, more and more APNs and nurses are choosing to take advocacy role, working to get health care policies, which reflects nursing’s perspective, implemented. The privilege of participating in association advocacy is an important benefit of membership in one’s professional organization (Matthews, 2012). The four spheres of political action in nursing workplace, government, professional organization, and community are well recognized as the areas where nurses can be politically involved. Majority of APNs acknowledge the importance of political activism for patient advocacy and overall nursing profession. Larger and larger numbers of APNs are currently politically active to some degree. APNs participation includes, but are not limited to, sending letters to legislators, attending lobbying days, contributing financially to advanced practice organizations and campaigns, engaging in social media, staying informed, and educating others. Political involvement does not need to be a time-consuming activity, any small amount of time and effort helps. Reference: Matthews, J. (2012). Role of professional organizations in advocating for the nursing profession. The Online Journal of Issues in Nursing, 17(3). doi: 10.3912/OJIN.Vol17No01Man03 Peer response, TD2, WEEK1 Hello Brittany, A number of challenging ethical issues are raised by a potential influenza pandemic. Ethical concerns associated with the planning, preparedness and responses to future pandemics are important to consider, making sure that the response efforts are not delayed in the occurrence of a pandemic. These include priority of access to healthcare resources with increased demand and possible shortages, responsibilities of healthcare workers with risks to their own health, and the fine balance between decreasing disease spread through isolation while protecting the right of individuals. According to Rid, & Emanuel (2014), the global response to the current Ebola outbreak has initially been slow and inadequate. Now that the response is picking up, the international community needs more focus on strengthening of health systems and infrastructure and less on experimental treatments (Rid, & Emanuel, 2014). Adoption of containment measures with a view to strengthen health systems and infrastructure is the most effective way to curb this epidemic and prevent future ones; it has positive externalities for health promotion and offers fair benefits to communities who engage in research in this outbreak (Rid, & Emanuel, 2014). Experimental Ebola treatments or vaccines should only be deployed in clinical trials. If trials are done, they must meet the eight ethical principles for research (Rid, & Emanuel, 2014). The international community needs to show that it can meet the challenge of this public health emergency, while learning the lessons for future Ebola and other epidemics (Rid, & Emanuel, 2014). Just like environmental pollutants, and pandemics have no boundaries. Ethics are essential in the process of policymaking regarding pandemic outbreak, and other emerging pandemic issues. Reference: Rid, A., & Emanuel, E. J. (2014). Ethical considerations of experimental interventions in the Ebola outbreak. The Lancet, 384(9957), 1896-1899. doi: http://dx.doi.org/10.1016/S0140-6736(14)61315-5 Week2, TD 1 Dr. Dragone and Class, I will have to admit that before starting this class, I never realized that nurses can make such a big impact on policy making. I have never been a big fan of policies and politics. That being said I am picking a topic that is close to home. Being a mother of 3 young children, every day I deal with the topic of nutrition for the kids in schools. Having good, and proper, nutrition in schools is the front line defense for childhood obesity. More than one third of our children are overweight in the US (Bratskeir, 2015). Changes are always being make and I understand that food needs to be appealing to children but if you were to compare what children across the world eat for their lunches at school the US can barely compare. For instance following are some basic lunches around the world (Bratskeir, 2015): •USA: Fried "popcorn" chicken, mashed potatoes, peas, fruit cup and a chocolate chip cookie •Brazil: Pork with mixed veggies, black beans and rice, salad, bread and baked plantains •Finland: Pea soup, beet salad, carrot salad, bread and pannakkau (dessert pancake) with fresh berries •France: Steak, carrots, green beans, cheese and fresh fruit •Greece: Baked chicken over orzo, stuffed grape leaves, tomato and cucumber salad, fresh oranges, and Greek yogurt with pomegranate seeds •Italy: Local fish on a bed of arugula, pasta with tomato sauce, caprese salad, baguette and some grapes •Spain: Sautéed shrimp over brown rice and vegetables, gazpacho, fresh peppers, bread and an orange Our children are in school for a major part of their lives. We expect them to get a good education so why not good meals. Childhood obesity on the rise and there are many factors that can cause this. I believe that using the incrementalism or pilot method to try and implement change would be best for my idea since I am looking at trying to make a change in pieces or steps (CCN, 2016). Incremental approach offers the best way to reduce the destructiveness of conflicts over difficult issues. This approach sometimes serves as a method to reduce the magnitude of the problem that can not be eliminated completely. I am a parent who either makes my children breakfast and lunches from home or I put money into a school lunch account for them to purchase lunches of choice during the week. So my idea is to start with one school at a time and only make lunches using freshest ingredients from the local farmes instead of serving pre-made or preserved food. The downfall of this may be an increase in the price of lunches. This price increase can be curbed be making a deal with the local farmers. References Bratskeir, K. (2015, February 25). Photos of school lunches from around the world will make American kids want to study abroad. retrieved from: http://www.huffingtonpost.com/2015/02/25/school-lunches- around-the-world_n_6746164.html Chamberlain College of Nursing, (2016). NR-506 Week 2: Context and process of policy making related to healthcare. [Online Lesson]. Downers Grove, IL. DeVry Education Group. Week 2, TD2 Dr. Dragone and class, One of the healthcare policies that I have experienced personally, which has been unsuccessful, is mandatory influenza vaccination at my workplace. From this year, to continue working for the organization that I am employed for, influenza vaccination has been made mandatory otherwise the next step is termination from the job. Few years before that, employees were given a choice between wearing a facemask during influenza season or getting the vaccine itself. Rather than focusing on systems and policies that actually prevent flu transmission, many institutions are now focused on setting a misguided and ineffective policy, which mandates that healthy healthcare workers wear a mask for eight to twelve hours while on duty if unvaccinated. There are multiple viruses, which cause influenza and influenza like illness. One size-fits-all vaccine mandates do not recognize biodiversity and the fact that individuals have unique biological and genetic factors that can make them more or less susceptible to suffering a vaccine reaction, injury or death. Influenza viruses constantly evolve and, depending upon the year, the flu shot may or may not match strains associated with reported influenza cases. According to Hooper, Breathnach, & Iqbal (2014), mandating vaccination should only be implemented if there is sufficient reason to think that this will increase vaccination rates and decrease the prevalence of influenza amongst staff and patients. It has been argued that there is good reason to think that the former claim is true, but only limited evidence to suggest that the latter is true (Hooper et al., 2014). The ethical arguments presented appear to favor consideration of a mandatory scheme although we accept this is partly due to a lack of data suggesting staff would be strongly opposed to this (Hooper et al., 2014). The existence of unofficial compulsion, whereby colleagues within the currently operating voluntary schemes put those who refuse to be vaccinated under undue pressure, also supports a change in the current system (Hooper et al., 2014). Using incrementalism as the policy making model to make the policy of mandatory influenza vaccination more effective, I would attempt to overcome employee resistance through careful education and open communication between hospital leadership and staff, as well as I will also imply the policies that permit certain reasonable exclusions and allow employees who cannot receive influenza vaccination to wear masks when they are in the presence of patients during the influenza season. Reference: Hooper, C. R., Breathnach, A., & Iqbal, R. (2014). Is there a case for mandating influenza vaccination in healthcare workers?. Anaesthesia, 69(2), 95-100. doi: 10.1111/anae.12561 Peer response Week2, TD 1 Hello Irma, This topic is close to my heart as I am a mother of three young school going children. This thought crosses my mind almost everyday on my drive to their schools. Teachers, coaches, and all educational staff should be required to attend a bus safety course at the start of each school year. Often, these are the people who are seen as role models of outlined safety rules who set the example for those who they mentor. Many children take the school bus to school. What may come, as more of a surprise is that this has been shown to be the safest way to get to school. That’s not to say that there aren’t important steps to taken to make sure that children stay safe while boarding, leaving, or riding the bus. Drivers especially need to be on the lookout for school buses and obey the law that says you must stop if the red lights are on and the stop arm is extended. One thing that needs to be done as a parent is to sit down with your children, especially if they ride the school bus and are waiting to get on the school bus. Children need to be told about the dangers that are out there. Tell them about what you need to do as a child or as a passenger. Even if the school bus stops, the stop arms out, the emergency equipment is activated, does not necessarily mean that the traffic that's approaching both from the front and the rear is going to stop, so kids need to be taught to look before they cross the road. Walking school bus program has the potential to improve children’s pedestrian safety behaviors through two ways: (1) walking with an adult decreases children's pedestrian risk by almost 70% and (2) adult leaders can teach and model safe street crossing behaviors on the way to and from school (Mendoza et al., 2012). Children's pedestrian safety is important to promoting active commuting, since it influences parents' decisions on their children's active commuting (Mendoza et al., 2012). Application of this walking school bus program by using incrementalism, or pilot study method can sure prove to increase the safety of school children near designated bus stops. Reference: Mendoza, J. A., Watson, K., Chen, T. A., Baranowski, T., Nicklas, T. A., Uscanga, D. K., & Hanfling, M. J. (2012). Impact of a pilot walking school bus intervention on children's pedestrian safety behaviors: A pilot study. Health & place, 18(1), 24-30. doi: 10.1016/j.healthplace.2011.07.004 Peer respone, Week 2, TD2 Hello Joel, The Baker Act has long been associated with problems since it’s enactment. There are those who say that the Baker Act is a tool to help those who need help and can’t come to terms with it. Then there are those who say that the Baker Act is being used improperly. While it is true that some people do need help regarding their mental health issues, involuntary confinement is a complex issue that can be used as a tool to help or as a tool for harm and should not be taken lightly. There may be individuals who present themselves as a potential harm to themselves and/or others and who do meet the criteria for the Baker Act, and in keeping with the law, will be involuntarily committed. Unfortunately for many, they were never a real threat to themselves or others and hereafter will have a mental health history of commitment. If an individual did not meet the criteria and this can be documented, it is an abuse of the Florida involuntary commitment law-the Baker Act. In a study by Brennaman (2015), delays to involuntary mental health examinations experienced by individuals in emergency departments (EDs) were studied. Being an ED nurse myself, I have seen way to often. The struggle to find a placement sometimes takes days, in the meanwhile already dried up resources of as ED department is misused even further. Florida statute specifies that involuntary mental health examinations shall take place only at state- designated facilities without unnecessary delay, no longer than 12•h until transfer for individuals in hospital EDs (Brennaman, 2015). Individuals in EDs needing involuntary mental health examinations sometimes wait for admission to inpatient units because of unavailability of mental health services (Brennaman, 2015). Almost 48.8% of participants waited longer than the 12 h maximum allowed by Florida law for transfer to an authorized facility (Brennaman, 2015). Factors that associated with prolonged waits were being male, increased age, being a Medicare beneficiary, and being intoxicated (Brennaman, 2015). Using dual signature based on incrementalism will definitely curb the misuse or overuse of Baker Act. Reference: Brennaman, L. (2015). Exceeding the Legal Time Limits for Involuntary Mental Health Examinations A Study of Emergency Department Delays. Policy, Politics, & Nursing Practice, 1527154415602296. doi: 10.1177/1527154415602296 Week 3, TD1 Describe the various elements necessary for effective leadership within a coalition. A coalition is made up of a group of individuals that share a common interest who are willing to work together to achieve a mutual goal. One of the first nursing coalitions that were formed in the Unites States was the American Society of Superintendents of Training Schools for Nurses in 1893, but today they are known as National League of Nurses (NLN). This coalition consists of nursing educators, educations agencies, healthcare organizations, and interested members of the public who share the common goal of building a strong and diverse nursing workforce by means of promoting excellence in nursing education. According to Brown, Feinberg, & Greenberg (2012), internal and external coalition functioning is an important predictor of coalition success that has been linked to perceived coalition effectiveness, coalition goal achievement, coalition ability to support evidence-based programs, and coalition sustainability. Understanding which aspects of coalition functioning best predict coalition success requires the development of valid measures of empirically unique coalition functioning constructs (Brown et al., 2012). Components of effective leadership within a coalition includes: 1) Clear organizational structure 2) Membership capacity to do the work 3) Sustainability Leadership strategies must include effective communication, conflict resolution, perceptions of fairness, and shared decision-making. Effective leadership, opportunities for leadership development, and staff supports are frequently identified as most essential elements of an effective coalition. Effective leaders are open, task oriented, and supportive to the group. For the past five years I have been employed with the same employer, and for the largest part credit goes to the effective and extremely supportive leadership. In last five years, from a community hospital, I have seen my hospital to become chest pain, and stroke certified. Recently we also got accredited as a Magnet hospital. We are very high on patient satisfaction score, and are rated among the best 25 companies to work for. Reference: Brown, L. D., Feinberg, M. E., & Greenberg, M. T. (2012). Measuring coalition functioning refining constructs through factor analysis. Health Education & Behavior, 39(4), 486-497. doi: 10.1177/1090198111419655 Week 3, TD2 Consider your chosen policy priority. How can you use evidence-based research to demonstrate the relationship of nursing practice to outcomes in your policy priority? It is obvious the childhood obesity is rising as a global epidemic with serious public health consequences. It is a significant health problem that is common among children and adolescents, contributing to chronic illnesses such as type 2 diabetes and heart disease (Rabbitt & Coyne, 2012). Primary prevention of obesity can prevent secondary complications in adulthood. Healthcare staff and policy makers have a responsibility to use the best evidence available to address the obesity problem. Middle and high schools in the school district near me have high- calorie, high-fat foods, and sodas in vending machines. My selected policy is for middle and high schools in the school district to eliminate vending machines or to stock vending machines with healthier food items. Schools can certainly promote healthier choices for students by providing healthy nutrition not only at breakfast and lunch, but also in the vending machines within the school campus. It is a long-term challenge requiring education, incentives as well as regulation. It must also involve parents and communities along with students and schools Evidence-based practice (EBP) involves the combination of the best evidence with nursing expertise and patient preferences to decide the highest quality of care. EBP challenges nurses to ask the question why, so that the best decision can be made to support care. As part of health care services, school nurses manage chronic illness, establish screening programs, provide health promotion education and prevention programs in schools. Research indicates that EBP in a school environment makes suitable use of health care and educational resources, decreases absenteeism rates, and improves health and educational outcomes. School vending machines should be stocked with healthier choices of nutritional value. Information about the healthier products must be made available to students. To assist students in making healthy decisions some other strategies can be used, such as posters to promote healthy choices, taste testing food before buying it, making healthy products less expensive, advertising on television at schools, stating nutrition facts during morning announcements, and making presentations about healthy eating in classrooms. The goal is to promote a healthier school nutrition environment by improving the nutritional quality of snacks available in vending machines. Children and adolescents spend a large portion of their time at school, which makes schools an optimal setting in which to encourage healthier food choices among students. Well- nourished students are better prepared to learn, to be active, as well as to continue making healthy choices as adults. In a study to track and assess children’s health status in Nevada and build relationships between researchers and school districts through the collection of mutually beneficial health data at a local level, all elementary schools in Nevada were sent a health survey for parents of kindergarten students to complete (Haboush et al., 2011). A total of 3,628 surveys were received with usable height and weight needed to calculate Body Mass Index (BMI) (Haboush et al., 2011). African American and Hispanic children had significantly higher BMI scores compared to Caucasian and Asian/Pacific Islander children, regardless of income (Haboush et al., 2011). Children who had diabetes or mental health concerns also had significantly higher mean BMIs compared to children without these health concerns (Haboush et al., 2011). Overall staff within the school districts felt that this surveillance system should be continued as data from this study provided important information subsequently used to guide programming and when applying for grants (Haboush et al., 2011). Our children’s welfare depends on community collaboration to create and implement data-driven initiatives to combat childhood obesity (Haboush et al., 2011). Reference: Haboush, A., Phebus, T., Ashby, D. T., Zaikina-Montgomery, H., & Kindig, K. (2011). Still unhealthy 2009: Building community research to identify risk factors and health outcomes in childhood obesity. Journal of community health, 36(1), 111-120. doi: 10.1007/s10900-010-9288-8 Rabbitt, A., & Coyne, I. (2012). Childhood obesity: Nurses' role in addressing the epidemic. British Journal of Nursing, 21(12). 731-735. Retrieved from: http://search.ebscohost.com.proxy.chamberlain.edu: 8080/login.aspx? direct=true&db=rzh&AN=104487392&site=nrc-live Week 3, TD1, Peer Response Hello Trudie, Leadership development programs are gaining in popularity and usually recognize the importance of both inner skills and interpersonal skills. The traditional view of leading others because they may not be able to lead is shifting to one based on shared power and community building. A leader can be anyone, regardless of position, who serves as an effective social change agent. Leadership development must empower individuals, and help people develop talents and attitudes that will enable them to become social change agents. Coalition-building needs to be done in more informed way, providing the structure to both enhance coalition performance and capture the results of that performance. Every coalition needs to carefully examined along with their framework in light of their own unique context and adapt accordingly. According to Hogg, Van Knippenberg, & Rast (2012), intergroup leadership, leadership of collaborative performance of different organizational groups or organizations is associated with unique intergroup challenges that are not addressed by traditional leadership theories. To address this lacuna, a theory of intergroup leadership was described (Hogg et al., 2012). Firmly grounded in research on social identity and intergroup relations, the theory proposes that effective intergroup performance rests on the leader's ability to construct an intergroup relational identity (Hogg et al., 2012). Key leadership actions required to establish such an identity (Hogg et al., 2012). Reference: Hogg, M. A., Van Knippenberg, D., & Rast, D. E. (2012). Intergroup leadership in Organizations: Leading across group and organizational boundaries. Academy of Management Review, 37(2), 232-255. doi: 10.5465/amr.2010.0221 Week 3, TD2, Peer response Hello Deena, In the past few years, significant advances have been made in health promotion to generate readily accessible systematic reviews of evidence on the effectiveness of interventions and programs. The influence of this evidence on policy and practice has however been unpredictable, and proponents of evidence-based practice are identifying ways to increase the use of research in decisions about health promotion interventions. An evidence agenda guideline needs to be proposed to assist advocates of evidence-based policy and practice to identify the health promotion goals they seek to influence against the required and available evidence. According to Bogenschneider, & Corbett (2011), it is important to tackle the challenge of how to engage and educate policymakers so that they can act on their interest in evidence- based policy, and take high quality research and analysis into account in their decision making. There is a way of doing public policy in more reflective manner, turning quality research into sound policy requires more than good report (Bogenschneider & Corbett, 2011). Reframing research in the accessible, nonpartisan, and timely manner that policy maker prefers is an important skill (Bogneschneider & Corbett, 2011). Public health policy has a profound impact on health status. Missing from the literature is a clear articulation of the definition of evidence-based policy and approaches to move the field forward. Policy-relevant evidence includes both epidemiological and narrative accounts. The key domains of evidence-based policy can be described as process to understand approaches to enhance the likelihood of policy adoption, content to identify specific policy elements that are likely to be effective, and outcomes to document the potential impact of policy. Actions to further evidence-based policy includes preparing and communicating data more effectively, using existing analytic tools more effectively, conducting policy surveillance, and tracking outcomes with different types of evidence. Reference: Bogenschneider, K., & Corbett, T. J. (2011). Evidence-based policymaking: Insights from policy- minded researchers and research-minded policymakers. Routledge. Retreived from: https://books.google.com/books Week 4, TD1 Analysis of Communication Skills Dr. Dragone and class, A good communication skill allows a person to express him or herself effectively and help people gather and disseminate information. If one wants to be an expert communicator, it is important to be effective at all points in the communication process, from sender through to receiver. One has to be comfortable with the different channels of communication, for example face to face, voice to voice, written, and so on. It can take a lot of effort to communicate effectively. However, it is essential to be able to communicate well, particularly in policy and politics. Effective communication skills work as a tool in persuading legislature to implement any policy-priority issue. By familiar with the skills needed to communicate effectively, one can learn how to communicate ideas clearly and effectively, and understand much more of the information that's being conveyed. As either a speaker or a listener, or as a writer or a reader, it is essential to make sure that the message is communicated accurately. This can be done in multiple ways like paying attention to words and actions, asking questions, and watching body language. These will all help to ensure that what is being said is what it is meant, and hear what is intended. Communication takes place interpersonally and interpersonally (Arnold & Boggs, 2015). For implementing policy-priority issues both intrapersonal and interpersonal skills are equally important. Interpersonal communication is defined as a reciprocal, interactive, dynamic process, having value, cultural, emotive, and cognitive variables that influence transmission, and reception (Arnold & Boggs, 2015). As per Pew Commission’s recommendation for twenty-first century nurses, is necessary to be competent in communication, and information technology effectively, and appropriately (Arnold & Boggs, 2015). The two communication skills that I perceive as being critical to implementing any policy-priority issue are as follows: • Writing and Research Skills – Extensive writing and research skills are critical in this role. Most importantly, one needs to have a firm handle on several different types of writing including press release, speeches, and social media posts. • Public Speaking and Presentation Skills - As a nurse political communicator, I might represent the organization, or party at various events. Public speaking and presentation skills must reflect those of a calm, knowledgeable, and poised professional. When assembling research for a presentation, it is essential to really understand the information. At this point in time, professional nursing role relationships and the use of relational communication in healthcare is more complex and multi-layered than ever before (Arnold & Boggs, 2015). Reference: Arnold, E. C., & Boggs, K. U. (2015). Interpersonal relationships: Professional communication skills for nurses. Elsevier Health Sciences. Retrieved from: http://agris.fao.org/agris search/search.do?recordID=US201300334827 Week 4, TD 2 Chllanges in Lobbying strategies. Discuss the best approach for communicating with your local legislator or policymaker in your policy-priority issue. What is your rationale for this approach? Dr. Dragone and class, It is important to communicate effectively with the local legislature or policymakers to get the best outcomes. There are multiple ways that I considered for approaching my local legislature to discuss my policy-priority issue. A presentation case can be made a good case good case if good strategy and good tactics in place enhance it. It always helpful to be on the look out for an opportunity to advance the case bit by bit. It is very rare to win everything at once. Politics is the art of the possible, and one usually achieves success by grasping the moment for a specific advance. These advances may well build up over time. The presentation has to be brief, times, aimed, well developed, well judged, and well prepared. A personal visit will definitely be my preferred approach of communication with my local legislature, as it gives me opportunity to be face to face with a senator or congressman, and there are better possibility of exchanging information and resolving issues. However, legislatures have endless demands on their time. Due to time constraints, my best option at that point will be via email. In today’s world where everything is time bound, emailing gives a opportunity of communication without being on time constrain. I can summaries my rationales as follows: emails are received fairly quickly, people don’t have to be present o receive a email, it can be sent any time of the day, and day, multiple copies can be sent to different people at same time, messages can be encrypted and sent and replied on personal convenient time. According to Broussard, S. & Broussard, B. (2013), nurses are increasingly using mobile and other devices, such as cell phones, smartphones, tablets, bar-coding scanners, monitoring equipment and bedside computers, to communicate with members of the health care team and with patients. Communication accomplished with such devices includes direct verbal communication, text-messaging, emailing, obtaining patient care information and accessing medical records for order entry and for documenting nursing care (Broussard, S. & Brousard, B., 2013). Problems that could occur with such communication methods include distraction, errors, de-personalized care, and violation of confidentiality and transmission of nosocomial pathogens (Broussard, S. & Brousard, B., 2013). Policies are needed to prevent inappropriate use of technological devices in patient care and to promote patient safety and quality care with their use (Broussard, S. & Brousard, B. 2013). Reference: Broussard, B. S., & Broussard, A. B. (2013). Using electronic communication safely in health care settings. Nursing for women's health, 17(1), 59-62. doi: 10.1111/1751-486X.12007 Week 4, TD 1, Peer response Hello Tanisha, It is vital to communicate effectively in policy and politics. It is mandatory for nurses to learn the language of politics and to be able to effectively communicate their requests in a way that political leaders, media and the public will find it understandable and credible. In person presenters need to be up-to-date with evidence based and relevant information. Decision makers need accurate, timely, and brief information about the health and financial effects of different policy options. Good communication skills need well-organized verbal delivery that considers word choice, effective use of nonverbal communication and physical movement and eye contact as well as a communication style that shows knowledge and credibility to pull in decision makers. On the other hand some communication traits can weakens the ability to a speaker to deliver a message including reading from cards, answering questions without knowing the correct answer, not honoring the start and finish time, or speaking to fast or to low, which may appear less professional. Political parties and politicians increasingly use the possibilities of the Internet to communicate interactively with citizens and vice versa (Kruikemeier et al., 2013). The Internet also offers opportunities for individual politicians to profile themselves (Kruikemeier et al., 2013). These developments are often said to bring politics closer to citizens, increasing their political engagement in politics (Kruikemeier et al., 2013). It was also found that political personalization positively moderates the effect of interactivity on political involvement, meaning that the effects of interactivity are even stronger in a personalized setting (Kruikemeier et al., 2013). Reference: Kruikemeier, S., van Noort, G., Vliegenthart, R., & de Vreese, C. H. (2013). Getting closer: The effects of personalized and interactive online political communication. European Journal of Communication. doi: 10.1177/0267323112464837 Week 4, TD2, Peer response To influence policymakers, one has to be able to effectively articulate information in a concise manner. It is essential for advanced practice nurses (APNs) to become politically engaged as key to promoting the healthcare interests of patients, communities and the profession and to become politically competent (Kostas-Polston et al., 2015). APNs must come to see political engagement as a professional obligation and health policy as something that they can shape rather than something that happens to them (Kostas-Polston et al., 2015). There are many options available for communicating with policymakers: email, letters, telephone calls, and tweets. The power of social media cannot be underestimated. Most senate and congressional staff are young and read your emails and follow Twitter. Although e-mail may not have the same visual effect as a pile of letters or a jammed fax machine, its speed is unmatched. While letters, faxes and phone calls are still extremely important advocacy tools; the advent of e-mail gives you one more option in communicating with policymakers. Coordinated e-mail campaigns are now an established advocacy tool that is increasingly used by interest groups and individual constituents. Its main advantage is the ability to get your message delivered promptly compared to perhaps finding your public official's phone lines busy, especially when an important vote is pending. Its disadvantage is the possibility that the message won't be read in time or at all. With that possibility, it is prudent to have an effective statement in the subject line of the e-mail in case it isn't read. The overall goal of healthcare reform is the provision of quality, safe and cost-effective healthcare for all Americans (Kostas-Polston et al., 2015). APNs are graduate prepared clinicians that focus on health and illness management and are strategically positioned to lead the way in shaping and implementing health policy priorities (Kostas-Polston et al., 2015). Reference: Kostas‐Polston, E. A., Thanavaro, J., Arvidson, C., & Taub, L. F. M. (2015). Advanced practice nursing: Shaping health through policy. Journal of the American Association of Nurse Practitioners, 27(1), 11-20. doi: 10.1002/2327-6924.12192 Week 5, TD1 People working in the healthcare system agree with the importance of quality, and many make it an explicit part of their personal and professional missions. When confronted by clear evidence of poor quality in their own practices and organizations, clinician and administrators rarely question the validity of the information and they respond quickly to solve the problems identified. Although quality continues to rise up in importance, and nearly every study identifies a room for improvement, something can be a hindrance in achieving the high quality desire. Quality is one of the ways to improve cost control. Accountable care organizations, scheduled to become part of the Medicare program under the Affordable Care Act, have been promoted as a way to improve health care quality, reduce growth in costs, and increase patients’ satisfaction (DeVore & Champion, 2011). Although it is unclear how these organizations will develop (DeVore & Champion, 2011). Yet in principle they will have to meet quality metrics, adopt improved care processes, assume risk, and provide incentives for population health and wellness (DeVore & Champion, 2011). Improvement in science, technology and care has offered the promise of better healthcare and improvement in health. But many healthcare systems have been unable to cope and with the acceleration of knowledge growth, thus creating a gap between the care that is possible and the care that is delivered. Many critics state the inconsistencies of quality and increasing costs of healthcare has posed the burden on healthcare system. Identifying improvements to current care delivery structures and translating approaches from high-performing systems to local delivery organizations will help to spread more reliable and cost effective care. These are the types of large-scale solutions that are necessary to contain health costs (Emanuel et al., 2012). Although many in the health industry perceive that it is not in their interest to contain national health spending, it is a fact that what cannot continue will not continue (Emanuel et al., 2012). As those costs become more and more unaffordable, people would severely restrict their consumption of health care and might forgo necessary care (Emanuel et al., 2012). Also governments could impose deep cuts in provider payments unrelated to value or the quality of care (Emanuel et al., 2012). Without an alternative innovative strategy, these options will become the default (Emanuel et al., 2012). They are not in the long-term interests of patients, employers, states, insurers, or providers (Emanuel et al., 2012). References: Emanuel, E., Tanden, N., Altman, S., Armstrong, S., Berwick, D., de Brantes, F., ... & Daschle, T. (2012). A systemic approach to containing health care spending. New England Journal of Medicine, 367(10), 949-954. Retreived from: http://www.nejm.org/doi/full/10.1056/neJmsb1205901 DeVore, S., & Champion, R. W. (2011). Driving population health through accountable care organizations. Health Affairs, 30(1), 41-50. doi: 10.1377/hlthaff.2010.0935 Week 5, TD2 Dr. Dragone and Class, Healthcare facilities get paid based on visits, length of stay, services provided, and/or diagnosis, and healthcare providers will get paid an agreed amount, regardless of how much money the facility brings in. The proposed payment policy changes to disentangle nursing costs have disadvantages, as well as advantages. I found this article to be very remarkable. The idea of nursing being its own entity is very intriguing. It shows the importance that we offer in patient care. I learned a lesson while working in the hospitals that nursing is not highly valued except as a person to take care of a patient in which I was seen as all other employees that may be also be taking care of the patient such as phlebotomist, nursing assistants, unit secretaries, respiratory therapist etc. All employees play a role to some degree. However, I never felt valued for the time and effort I took to get my degree, especially my bachelor’s in nursing. One of the biggest advantage that I noticed right away, of disentangling nursing from hospital room and board charges are that nursing can thus become a tangible asset which can show the value of nursing and thus be able to justify the investment in the nursing profession and also how nursing management can then use that daily nursing charge data to monitor and measure the efficacy related to patient care (Rutherford, 2012). Secondly, increased funding can heighten the standard of care as better investment sometimes can mean better education, and higher standards of care. More research will definitely lead to better patients’ outcomes. I am currently working in an emergency room, and a disadvantage I can see is how it could affect reimbursement to all involved. Costs could increase for the patient and payments could decrease for hospitals and physicians, as separate costs would need to be included for nursing. The concept of helping nursing become acknowledged is extremely exciting. However, thinking on the side of the consumer I really would not like to pay more for healthcare then I already am. Also, however it is looked at nursing is primarily a noble profession, where people embracing nursing as a profession still have the core value of serving others. Disentangling nursing cost from the hospital and other charges will objectify nursing even further. The foundation of the health care delivery system is its workforce, including the 2.8 million registered nurses (RNs) who provide health care services in countless settings (Auerbach et al., 2013). The importance of RNs is expected to increase in the coming decades, as new models of care delivery, global payment, and a greater emphasis on prevention is embraced (Auerbach et al., 2013). These and other changes associated with health care reform will require the provision of holistic care, greater care coordination, greater adherence to protocols, and improved management of chronic disease — roles that are inherently aligned with the nursing model of care (Auerbach et al., 2013). Reference: Auerbach, D. I., Staiger, D. O., Muench, U., & Buerhaus, P. I. (2013). The nursing workforce in an era of health care reform. New England Journal of Medicine, 368(16), 1470-1472. Retrieved from: http://www.aahs.org/medstaff/wp content/uploads/NEJMNursingWorkforce2013.pdf Rutherford, M. M. (2012). Nursing Is the Room Rate. Nursing Economics, 30(4), 193-200 Retrieved from: http://europepmc.org/abstract/med/22970549 Week 5, TD1, Peer response Our fragmented health care delivery system delivers poor-quality, high-cost care. We cannot achieve a higher-performing health system without reorganization at the practice, community, state, and national levels. Our vision of health care delivery is not out of reach; some delivery systems have achieved these attributes, and they have done so in a variety of ways. According to Fineberg (2012), the country's political appetite for further reform may be sated, but unless we attend to the major sources of waste and impediments to performance, the United States will remain vulnerable to an excessively costly health system that delivers incommensurate health benefit. The joint problem of relatively low performance and high cost stands in the way of a successful, sustainable health system (Fineberg, 2012). These concerns are intensified by the federal debt crisis, which has exacerbated worries about the capacity of individuals, families, and the nation to afford health care yet also meet other essential needs over time(Fineberg, 2012). And there is no way to deal with Medicare without restraining the total cost of care: cost shifting will not save money overall, and none of these parties can afford to bear any more of the load (Fineberg, 2012). The only morally and politically acceptable way to curtail costs is to take steps to preserve or enhance the performance of the health system, thus getting more value for dollars spent (Fineberg, 2012). In the battle to control health care spending, the stakes are high. The more the government devotes to health costs, the less it has available for investing in jobs, education, and other pressing societal needs. With health insurance premiums running so high, many small employers simply cannot afford to offer health coverage and raise wages for their workers. And large firms in many industries must contend with crippling obligations to thousands of retirees with health benefits. These include not only the accountable care systems you’ve read about here, but also new incentives that encourage providers and patients to make the best health care choices, efforts to expand access to medical homes and primary care, and initiatives to promote greater use of information technologies to focus health care resources where they’re needed most. There has been a long debate on the subject of reforming the health system: on the availability of health insurance, access to care, the supply and education of doctors and nurses, the safety and quality of health care, the evaluation of new medical technology, the payment system for doctors and hospitals, shortcomings in regulation of drugs and devices, the fragmented organization of care, the rising cost and diminishing affordability of care, and other dimensions of our remarkably durable health crisis (Fineberg, 2012). Foundation, the Engelberg Center for Health Care Reform of the Brookings Institution issued another comprehensive prescription, describing a dozen key reforms and many specific actions in four main categories: foundational changes in information, evaluation, and human resources; reforms in the provider- payment system to encourage accountability in order to achieve better outcomes and lower cost; improvements in insurance markets so that insurers would compete to add value rather than to enroll lower-risk beneficiaries; and changes that would enable individual patients to make better choices (Fineberg, 2012). In addition, the report identifies 10 approaches to reducing care-related costs, administrative costs, and waste that could potentially achieve the desired savings (Fineberg, 2012). Reference: Fineberg, H. V. (2012). A successful and sustainable health system—how to get there from here. New England Journal of Medicine, 366(11), 1020-1027. doi: 10.1056/NEJMsa1114777 Week 5, TD2, Peer response Health care policy and programs are continuously changing and being redefined, and the constant change influences the composition, size and activities of the health care workforce. The increased potential for large financial gains in the health care industry increased the conflict between professional principles and expectations for profit. Which clinicians can be reimbursed for providing services clearly has an impact on who performs those services. The key issue has been how to acknowledge the overlap of nursing with other occupations and still maintain nursing's core identity. Shrinking dollars increase the need for health care stakeholders to clearly understand nursing’s worth (Rutherford, 2012). For nursing to assure an adequate investment in nurses, it needs to articulate its value drivers (Rutherford, 2012). Nursing revenue offers a data source that reflects stakeholder choices and patient needs (Rutherford, 2012). The daily nursing billing supports hospital payment and provides cost data, important for hospital financial decision making (Rutherford, 2012). This revenue is a tangible asset reflecting nursing value and can be used to justify an investment in the profession (Rutherford, 2012). Nursing leadership can use this daily nursing charge data to monitor and measure the impact of efficiencies related to nursing care (Rutherford, 2012). Reference: Ruterford, M. M. (2012). Nursing is the room rate. CNE series, 30(4), 193-206. Reterived from: https://www.nursingeconomics.net/ce/2014/article3004193206.pdf Week 6, TD1 Professional Development in Health Care Policy Making (graded) Using the spectrum of political competencies located in your textbook, first identify were you are right now. Then consider your selected healthcare issue, at which level of political competencies do you need to be at to have the greatest positive impact on your issue. Dr. Dragone and class, Nurses have individual views on health care issues and influence health care policies in different ways (Arabi, Rafii, Forough, Cheraghi, & Ghiyasvandian (2014). With a common understanding of nurses’ policy influence as a concept, nurses will recognize the importance of policy making in the health sector and their influence on this process and also on patients’ outcomes (Arabi et al., 2014). According to Mason, Gardner, Outlaw, & O’Grady (2016), there are four stages of competencies: learning the ropes, participating in democracy, influencing and advocating, and using advanced political skills. I find myself in in the stage of learning the ropes. Right now I am learning about policy and politics, the government, identifying elected officials, and gaining more information about how to become active in policymaking. Prior to taking this course, I did not have any knowledge on policymaking. The purpose of learning the rope of policy, politics, and advocacy is to influence health policy. The only way to become an effective political leader, advocate or activist is through experience, and practice, so that one can apply strategies and skills learned to influencing decisions made by governments, communities, organizations, and associations. My selected healthcare issue is on childhood obesity. Influencing and advocating seems to be the most appropriate level of political competencies which has assist me to make the greatest positive impact on my selected issue. Nurses’ influence on health policy protects the quality of care by access to required recourses and opportunities (Arabi et al., 2014). This is a new and important concept for nursing; however, research studies on policy influence of nurses in health care sector are lacking a basic conceptual understanding of what this concept represents (Arabi et al., 2014). As a nurse, I am in a position to influence health care policies while I advocate for the community that I live in. References: Arabi, A., Rafii, F., Cheraghi, M.A., & Ghiyasvandian, S. (2014). Nurses’ policy influence: A concept analysis. Iranian Journal of Nursing and Midwifery Research 19(3), 315- 322 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 Week 6, TD2 Dr. Dragone and Class, It seems as if social media has taken over the communication world. Electronic games, computers, tablets, cell phones, Facebook, Instagram are just a few to name. This is both good and bad. Internet users state that they often seek information on the web that often influences their decisions and we have come to recognize that people rely on this information in their decision making (Gagnon & Sabus, 2015). My topic of healthier food in schools is a topic that, I believe, would benefit from the use of a variety of media in order to get my point across. Before trying to contact the appropriate legislator one must know the preferred media preferences in contacting them (Weiss, White, Stohr & Willis, 2015). With that in mind I have tried emailing, as the world seems to work best this way. To try and prove my point I have found several impressive articles/studies that show great outcomes that I plan to show the legislator. It shows how successful other school districts have been with offering healthier food choices to better health and reduce childhood obesity. I also plan to show my power point presentation along with the articles. I do realize that I will need to influence my legislator as well as families (in time) for change to occur, one step at a time. According to Ventola (2014), when used wisely and prudently, social media sites and platforms offer the potential to promote individual and public health, as well as professional development and advancement. However, when used carelessly, the dangers these technologies pose to HCPs are formidable (Ventola, 2014). Guidelines issued by health care organizations and professional societies provide sound and useful principles that health care professionals should follow to avoid pitfalls (Ventola, 2014). There can be many dangers of using social media including poor quality of information, damage to professional image, and violation of patient’s privacy. Among all the disadvantages, what really stands out for me is the poor quality of information. There is no proof of quality and reliability of the information provided on online sources. This kind of information is usually unreferenced, incomplete, and informal. Being an emergency room nurse, multiple times I have observed that patients coming to emergency room are apprehensive about their condition, as they have referred to websites like WebMD. Such information not only misguides people about their disease process, it can also increase the anxiety and apprehension. Unreliable information defeats the purpose of being helpful; instead in such scenario it acts as a hindrance in recovery of the patient. References: Gagnon, K., & Sabus, C. (2015). Professionalism in a digital age: opportunities and considerations for using social media in health care. Physical Therapy, 95(3), 406- 414. doi:10.2522/ptj.20130227 Weiss, D., White, J. M., Stohr, R. A., & Willis, M. (2015). Influencing healthcare policy: Implications of state legislator information source preferences for public relations practitioners and public information officers. Online Journal of Communication & Media Technologies, 5 (1), 114-135. Retrieved from: http://cjdept.unm.edu/people/faculty/profile/Weiss%20White%20OJCMT %20article%20-%20January%202015.pdf Ventola, C. L. (2014). Social media and health care professionals: benefits, risks, and best practices. Pharmacy and Therapeutics, 39(7), 491. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103576/ Week 6, TD1, Peer response Nurses learn the skills of politics and policy by mentoring, role modeling, and practice. There are hundreds of causes and issues to stimulate our interest, we as students decide how much energy, times, and interest to put forth. The political arena will open many doors for us nurses. According to Mason, Gardner, Outlaw, & O’Grady (2016), the spectrum of political competencies portrays the range of activities from which nurses can draw to influence health and health care. It demonstrates the breadth and variety of competencies ranging from novice to more sophisticated levels, including running for elective office (Mason et al., 2016). The skills can be learned and applied in a variety of activities aimed at improving health and health care (Mason et al., 2016). This class has most positively has enlightened my understanding on health care policy and on the impact nurses can have on policy and politics. I find myself in the learning the ropes phase of spectrum of learning the competencies as I had very limited understanding on health care policy. I am hoping to move up in the spectrum by end of this class to better influence my policy priority issue. 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 Week 6, TD2, Peer response Hello Melanie, Social and electronic media have tremendous potential for strengthening personal relationships and providing valuable information to health care consumers, as well as affording nurses a valuable opportunity to interface with colleagues from around the world. Nurses need to be aware of the potential consequences of disclosing patient-related information via social media, and mindful of employer policies, relevant state and federal laws, and professional standards regarding patient privacy and confidentiality and its application to social and electronic media. By being careful and conscientious, nurses may enjoy the personal and professional benefits of social and electronic media without violating patient privacy and confidentiality. Social media can be a very effective way of communicating in nursing, but guidelines for appropriate use by healthcare providers are essential (Spector, & Kappel, 2012). Guidelines for appropriate use of social media by nurses should be made readily available (Spector, & Kappel, 2012). Next steps should include development of organizational level policies and educational programs on the use of social media (Spector, & Kappel, 2012). Social media is instantaneous and powerful, carrying messages that can be profound or profane (Spector, & Kappel, 2012). It is hardly an overstatement that social media is transforming the way that people communicate (Spector, & Kappel, 2012). Social media can be a very effective way of communicating in nursing but also presents regulatory concerns (Spector, & Kappel, 2012). These concerns should be addressed prior to handling sensitive information on social media as it very easy to cross the line and violate patients’ privacy. Reference: Spector, N., & Kappel, D. M. (2012). Guidelines for using electronic and social media: The regulatory perspective. Online journal of issues in nursing, 17(3), 1_11. doi: 10.3912/OJIN.Vol17No03Man01 Week 7, TD1 RN as Health Care Policy Leader (graded) As a health policy professional leader, communicating with lay audiences is an important skill in promoting the health of the community for master prepared registered nurses. Develop a concise position statement regarding research findings and recommendations by experts as they relate to workplace support for breast feeding mothers, medical marijuana services in the community or a community service administered by Family Nurse Practitioners (if you pick this one be specific about the type of community service). Dr. Dragone and class, Nurses working in the community have been a surge in the last few years. Parrish nursing in the spiritual community is one example. In my area we have a community health center that a physician started many years ago but is now run primarily by nurses. There is also a health center at the women and children homeless shelter that is fully run by nurses, with the volunteers from schools of nursing and nurses in the community. These are the few examples, which prove that how effective nurses can be as community leaders advocating health care policies for the betterment. One key way to improve the health care system is to transform the workforce so that it allows for more interdisciplinary and team-based patient care and enables nurses to practice to the full extent of their training. But the path from fragmented care to a system in which all professionals are free and able to work together as full partners is murky. Breast feeding at workplace is one of many important topics, which need to be explored, and new laws need to be developed. According to Murtagh, & Moulton (2011), research shows that supportive state laws correlate with higher rates, yet by 2009, only 23 states had adopted any laws to encourage breastfeeding in the workplace. Federal law provided virtually no protection to working mothers until the 2010 enactment of the “reasonable break time” provision of the Patient Protection and Affordable Care Act (Murtagh, & Moulton, 2011). This provision nonetheless leaves many working mothers uncovered, requires break time only to pump for (not feed) children younger than 1 year, and exempts small employers that demonstrate hardship (Murtagh, & Moulton 2011). Public health professionals should explore ways to improve legal support for all working mothers wishing to breastfeed (Murtagh, & Moulton 2011). Support for breastfeeding in the workplace includes several types of employee benefits and services, including writing corporate policies to support breastfeeding women; teaching employees about breastfeeding; providing designated private space for breastfeeding or expressing milk; allowing flexible scheduling to support milk expression during work; giving mothers options for returning to work, such as teleworking, part-time work, and extended maternity leave; providing on-site or near-site child care; providing high-quality breast pumps; and offering professional lactation management services and support. This can be achieved by: providing educational materials to employers about how supporting their employees who breastfeed benefits employers, establish a model lactation support program for all states employees, promote legislation to support work site lactation programs through incentives, and lastly creating work site recognition programs to honor employers who support their breastfeeding employees. Hospital routines to encourage and support the initiation and sustaining of exclusive breastfeeding should be based on the American Academy of Pediatrics-endorsed World Health organization/United Nations Children’s Emergency Fund “Ten Steps to Successful Breastfeeding” (Eidelman et al., 2012). National strategies supported by the US Surgeon General’s Call to Action, the Centers for Disease Control and Prevention, and The Joint Commission is involved to facilitate breastfeeding practices in US hospitals and communities (Eidelman et al., 2012). Reference: Eidelman, A. I., Schanler, R. J., Johnston, M., Landers, S., Noble, L., Szucs, K., & Viehmann, L. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e827-e841. Murtagh, L., & Moulton, A. D. (2011). Working mothers, breastfeeding, and the law. American Journal of Public Health, 101(2), 217-223. doi: 10.2105/AJPH.2009.185280 Week 7, TD2 Population Based Care (graded) Find an article that describes holistic care of a client with a chronic illness. As a leader in healthcare policy, what additional healthcare policy changes would you advocate for to improve the health of this population? Florence Nightingale, widely known as the founder of modern nursing believed in unity, wellness, and the interrelationship of human beings and their environment, and is considered to be one of the first holistic nurses. Holistic nurses integrate various healing modalities to complement conventional medical therapies, acknowledging that individuals are unique, and two people with the same disease may be treated very differently. According to Zamanzadeh, Jasemi, Valizadeh, Keogh, & Taleghani (2015), holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method (Zamanzadeh et al., 2015). Examining the effective factors in nurses’ provision of holistic care can help with enhancing it (Zamanzadeh et al., 2015) . Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring (Zamanzadeh et al., 2015). Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring (Zamanzadeh et al., 2015). Although meeting patients’ spiritual needs is important, many nurses are uncertain about what spiritual care involves and lack confidence in this area. Holistic care is a comprehensive model of caring which is believed to be the heart of the science of nursing (Zamanzadeh et al., 2015).The philosophy behind holistic care is based on the idea of holism which emphasizes that for human beings the whole is greater than the sum of its parts and that mind and spirit affect the body (Zamanzadeh et al., 2015). Holistic care is described as a behavior that recognizes a person as a whole and acknowledges the interdependence among one's biological, social, psychological, and spiritual aspects (Zamanzadeh et al., 2015). Holistic care includes a wide range of approaches, including medication, education, communication, self-help, and complementary treatment (Zamanzadeh et al., 2015). In holistic nursing, all aspects of patients and their effects on the treatment process are considered and the patients’ thoughts, emotions, cultures, opinions, and attitudes are factored in as contributing to recovery, happiness, and satisfaction (Zamanzadeh et al., 2015). Holistic care respects human dignity: The relationship between the providers of health care and the patients is based on respect, relative openness, equality, and mutuality and patients participate in decision making in this kind of caring (Zamanzadeh et al., 2015). Incorporating spiritual care into pre and post registration education will enhance nurses’ confidence and improve patient wellbeing and satisfaction. It could be argued that this has the potential to improve outcomes and reduce demand on resources. Ultimately, administering good spiritual care has the dual effect of benefiting both patients and caregivers. Holistic care should be streamlined just like medical care. It should be made as a part of mandatory education in schools of nursing. No two patients are alike, holistic care gives nurses a chance to think and act outside the box and provide best possible care to the patients and their families. Reference: Zamanzadeh, V., Jasemi, M., Valizadeh, L., Keogh, B., & Taleghani, F. (2015). Effective factors in providing holistic care: A qualitative study. Indian journal of palliative care, 21(2), 214. http://dx.doi.org/10.4103%2F0973-1075.156506 Week 7, TD1, Peer response Hello Viveca, The term medical marijuana refers to treating a disease or symptom with the whole unprocessed marijuana plant or its basic extracts. The FDA (Food and Drug administration) has not recognized or approved the marijuana plant as medicine. However, scientific study of the chemicals in marijuana called cannabinoids has led to two FDA-approved medications in pill • form. Regular medicinal use of marijuana is a fairly new practice. For that reason, its effects on • people who are weakened because of age or illness are still relatively unknown. Scientists need • to conduct more research to determine if this is the case. According to Reinarman, Nunberg, Lanthier & Heddleston (20122), the medical literature contains a growing number of studies on cannabinoids as well as case studies and anecdotal reports suggesting therapeutic potential. Patient characteristics, self-reported presenting symptoms, physician evaluations, other treatments tried, other drug use, and medical marijuana use practices are few characteristics that need to be evaluated (Reinarman et el., 2011). Pain, insomnia, and anxiety were the most common conditions for which evaluating physicians recommended medical marijuana (Reinarman et al., 2011). Shifts in the medical marijuana patient population over time, the need for further research, and the issue of diversion are discussed (Reinarman et al., 2011). Above all else, the underlying mission of all efforts is to help the millions of people who can benefit from cannabis access. Reference: Reinarman, C., Nunberg, H., Lanthier, F., & Heddleston, T. (2011). Who are medical marijuana patients? Population characteristics from nine California assessment clinics. Journal of psychoactive drugs, 43(2), 128-135. doi:10.1080/02791072.2011.587700 Week 7, TD2, Peer response Hello Diane, For many years, there has been a push to increase the focus on treating the patient as a whole person, not just his or her medical condition often referred to as holistic care. In recent years, there has been an increasing awareness of the amount of pain patients with chronic wounds experience while living with unresolved wounds. Quite understandably, much of the initial interest in pain in these patients has focused on pain at dressing change. However, clinicians must remember to place this pain experience within a full wound and pain assessment, to allow patients and clinicians to work together to resolve pain issues within the context of the whole pain experience, and thus to focus on the whole person, not just the wound. According to Leaper, Assadian, & Edmiston (2015), infection is the likeliest single cause of delayed healing in healing of chronic open wounds by secondary intention. If neglected it can progress from contamination to colonization and local infection through to systemic infection, sepsis and multiple organ dysfunction syndrome, and it can be life-threatening. Infection in chronic wounds is not as easy to define as in acute wounds, and is complicated by the presence of biofilms (Leaper et al., 2015). Maintenance debridement and use of topical antimicrobials (antiseptics) are more effective than antibiotics, which should be reserved for treating spreading local and systemic infection (Leaper et al., 2015). The continuing rise of antimicrobial resistance to antibiotics should lead us to reserve their use for these indications, as no new effective antibiotics are in the research pipeline (Leaper et al., 2015). Antiseptics are effective through many mechanisms of action, unlike antibiotics, which makes the development of resistance to them unlikely (Leaper et al., 2015). There is little evidence to support the theoretical risk that antiseptics select resistant pathogens (Leaper et al., 2015). However, within the framework of holistic care, clinicians must place the dressing change within the context of total pain management. Within wound care management, clinicians must be careful to ensure that the patient is the focal point of care, with all aspects of pain management considered within a package of care that reflects a move away from considering the wound to considering the "person." Reference: Leaper, D., Assadian, O., & Edmiston, C. E. (2015). Approach to chronic wound infections. British Journal of Dermatology, 173(2), 351-358. doi: 10.1111/bjd.13677