Week 1 discussion

The Role of Government in the U.S. Health Care System

As stated in the course text, Health Care Delivery in the
United States, “the health care enterprise is one of the most important parts
of the U.S. social system and of our economic system as well” (Kovner and
Knickman, 2011, p. 4); however, with millions of citizens uninsured, rising
costs, massive health disparities, and the need to improve quality and access,
many view health care as a broken system. As such, it continues to be a
significant political issue in the United States. Most agree that something
needs to be done to fix the health care system, but the methods and solutions
for addressing problems vary greatly, particularly with respect to the role
government should play. Proponents of varying approaches often have strong,
emotional opinions, making compromise difficult.

In this Discussion, you will consider the role of government
in health care, and you will examine the impact of a social, economic,
technological, ethical, or legal issue on health care delivery.

To prepare:

With this week’s Learning Resources in mind, consider this
question: Is health care a right or a privilege?

Review the media presentation for this week, focusing on the
role of the government in health care including Affordable Care Act.

Pinpoint a social, economic, technological, ethical, or
legal issue that could, or has, affected health care delivery in the United
States.

Locate a current article from the popular press (within the
past 6 months) related to the health care issue you identified. How does this
article inform your understanding of the influence of your selected issue in
the health care debate?

By Day 3

Post your position on whether health care in the United
States is a right or a privilege, and explain what you believe to be the proper
role of government in health care. Justify your position. Explain how the
social, economic, technological, ethical, or legal issue you selected is
impacting health care delivery and whether this issue should be addressed by
the government or by private entities. Identify the article you selected, and
explain how this article informs your stance.

Read a selection of your colleagues’ responses. Focus
particularly on those questions raised to which you can add comments based on
shared experiences or situations. Consider how your colleagues’ postings
reflect and/or differ from your own perceptions and opinions.

By Day 6

Respond to at least two of your colleagues on two different
days in one or more of the following ways:

Ask a probing question, substantiated with additional
background information, evidence, or research using an in-text citation in APA
format.

Share an insight from having read your colleagues’ postings,
synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional
research.

Make a suggestion based on additional evidence drawn from
readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional
insights or contrasting perspectives based on readings and evidence.

Reference:

Kovner, A. R., & Knickman, J. R. (Eds.). (2011). Health
care delivery in the United States (10th ed.). New York, NY: Springer
Publishing.

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Week 2 discussion

Nurses as Leaders in Health Care Reform

As health care delivery in the United States continues to
evolve, either through mandates, improved technologies and training, or other
drivers, nurses remain at the forefront in facilitating the success of new
initiatives. In 2010, the Institute of Medicine formed a committee of experts
to address the following question: “What roles can nursing assume to address
the increasing demand for safe, high-quality, and effective health care
services?” In the final report of the committee, The Future of Nursing: Leading
Change, Advancing Health, the authors stated:

This report offers recommendations that collectively serve
as a blueprint to (1) ensure that nurses can practice to the full extent of
their education and training, (2) improve nursing education, (3) provide
opportunities for nurses to assume leadership positions and to serve as full
partners in health care redesign and improvement efforts, and (4) improve data
collection for workforce planning and policy making. (p. 10)

For this Discussion, you will focus on the research
recommendations presented by the committee concerning the role of nurses as
leaders. The committee members believe that answers to these research questions
are needed to advance the profession of nursing and to further expand their
role in health care reform and improvement.

To prepare:

Review Chapter 7 in The Future of Nursing: Leading Change,
Advancing Health report provided in the Learning Resources. Focus on the
information in Box 7.3, “Research Priorities for Transforming Nursing Leadership.”

Select one of the research priorities listed in Box 7.3 that
is of particular interest to you and applicable to your career interests.
Consider the benefits and challenges of researching and addressing this
priority in nursing.

Using the Walden library, identify two to three current
articles that address your selected research priority. Consider the current
state of research efforts on this priority.

Reflect on how the research findings for your area of
priority impact nurses as leaders in organizations and health care reform. Why
is research on this priority important?

By Day 3

Post a description of the priority you selected and the
benefits and challenges of further researching this area. Provide an overview
of the articles you found (using appropriate APA citations) relating to this
priority, and highlight any key findings. Explain how continued research in
this area could strengthen the ability of nurses to lead in both individual
organizations and as advocates of health care reform.

Read a selection of your colleagues’ responses. Focus
particularly on those questions raised to which you can add comments based on
shared experiences or situations. Consider how your colleagues’ postings
reflect and/or differ from your own perceptions and opinions. Review the
Learning Resources for any clarification needed before responding.

By Day 6

Respond to at least two of your colleagues on two different
days in one or more of the following ways:

Ask a probing question, substantiated with additional
background information, evidence, or research using an in-text citation in APA
format.

Share an insight from having read your colleagues’ postings,
synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional
research.

Make a suggestion based on additional evidence drawn from
readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional
insights or contrasting perspectives based on readings and evidence.

Reference:

National Academy of Sciences. (2011) The future of nursing:
Leading change, advancing health.

Retrieved from https://download.nap.edu/catalog.php?record_id=12956

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Week 3 discussion

Financing of Health Care

With coinciding concerns about health care costs and the
imperative to improve quality of care, health care providers and others face
difficult decisions in the effort to achieve an appropriate balance. Such
decisions often are addressed in the policy arena. How do policymakers evaluate
which health care services should be financed through government programs? How
do ethics-related questions and other considerations play into this evaluation
process? Is it possible to contain costs and provide accessible, high-quality
care to all, or is the tension between cost and care inherent in the U.S.
health care delivery system? These questions are central to health care
financing decisions in the United States.

For this Discussion, you will focus on the policy
decision-making process that determines what types of care are covered by
public and private insurers and the ethical aspects of such financial
decisions.

To prepare:

Read the following case study, “Hard Economic and Finance
Choices in US Healthcare” (Milstead):

Case Study 1: Hard Economic and Finance Choices in US
Healthcare

Applied economics is all about managing scarce resources.
Economics is an amoral field of study: it is neither moral nor immoral.
Morality and values are determined by individuals at the personal level and by
group consensus or majority opinion at the national level. State and federal
governments determine the ‘will of the people’ about how to use scarce
resources for the good of a nation.

The U.S. health care system is an exemplar of scarcity:
primary care physicians, substance abuse treatment centers, trauma centers,
registered nurses, and the money to pay for goods and services. Finance is all
about how to pay for goods and services. The Medicare Payment Advisory
Commission (MedPAC) is appointed by the Executive branch of the federal
government to make decisions about what the Medicare program will and will not pay
for. In this role, MedPAC makes decisions about medications, procedures and
treatments. Examples of MedPAC decisions include coverage for left ventricular
assistive devices as a destination therapy, coverage for bariatric surgery, and
in 2010, coverage of the drug Provengeâ„¢. By law, MedPAC is not allowed to use
price or cost of any treatment in its decision-making processes.

Review the information in the Washington Post article
“Review of Prostate Cancer Drugs Provenge Renews Medical Cost-Benefit Debate” in
the Learning Resources.

Consider how policy decisions currently are made about what
will and will not be paid for and what changes, if any, could improve the
process.

Reflect on how the Washington Post example illustrates the
tension between cost and care.

By Day 3

Post your analysis and assessment of the ethical and
economic challenges related to policy decisions such as those presented in the
Washington Post article. How does this type of situation contribute to the
tension between cost and care? Substantiate your response with at least two
outside resources.

By Day 6

Respond to at least two of your colleagues on two different
days in one or more of the following ways:

Ask a probing question, substantiated with additional
background information, evidence, or research using an in-text citation in APA
format.

Share an insight from having read your colleagues’ postings,
synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional
research.

Make a suggestion based on additional evidence drawn from
readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional
insights or contrasting perspectives based on readings and evidence.

References:

National Health Expenditures 2010 Highlights, Centers for
Medicare & Medicaid Services (n.d.). Retrieved from
https://www.cms.gov/NationalHealthExpendData/downloads/highlights.pdf.

Milstead, J. A. (2013). Health policy and politics: A
nurse’s guide (3rd ed.). Sudbury, MA: Jones and Bartlett Publishers.

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Week 4 discussion

Key Health Determinants

Did you know that the United States has a higher rate of
infant mortality than Japan (CIA, n.d.)? Or, as Dr. Beilenson states in this
week’s media presentation, that “your zip code that you live in makes more
difference in your health and well-being than the genetic code that you’re born
with?” What causes these differences in health outcomes?

To effectively develop policies and programs to improve
population health, it is useful to use a framework to guide the process.
Different organizations and governmental agencies (for example, Healthy People
2020) have created a variety of such frameworks, which establish measures for
assessing population health. These measures frequently are derived from the
examination of epidemiologic data, which include key measures of population
health such as mortality, morbidity, life expectancy, etc. Within each measure
are a variety of progress indicators that use epidemiologic data to assess
improvement or change.

For this Discussion, you will apply a framework developed by
Kindig, Asada, and Booske (2008) to a population health issue of interest to
you. This framework includes five key health determinants that should be
considered when developing policies and programs to improve population health:
access to health care, individual behavior, social environment, physical
environment, and genetics.

To prepare:

Review the article “A Population Health Framework for
Setting National and State Health Goals,” focusing on population health
determinants.

Review the information in the blog post “What Is Population
Health?”

With this information in mind, elect a population health
issue that is of interest to you.

Using this week’s Learning Resources, the Walden Library,
and other relevant resources, conduct a search to locate current data on your
population health issue.

Consider how epidemiologic data has been used to design
population health measures and policy initiatives in addressing this issue.

By Day 3

Post a summary of how the five population health
determinants (access to health care, individual behavior, social environment,
physical environment, and genetics) affect your selected health issue, and
which determinants you think are most impactful for that particular issue and
why. Explain how epidemiologic data supports the significance of your issue,
and explain how this data has been used in designing population health measures
and policy initiatives.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different
days in one or more of the following ways:

Ask a probing question, substantiated with additional background
information, evidence, or research using an in-text citation in APA format.

Share an insight from having read your colleagues’ postings,
synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional
research.

Make a suggestion based on additional evidence drawn from
readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional
insights or contrasting perspectives based on readings and evidence.

References:

Central Intelligence Agency. (n.d.) The world factbook.
Retrieved from https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

Kindig, D., Asada, Y., & Booske, B. (2008). A population
health framework for setting national and state health goals. JAMA, 299(17),
2081–2083. doi: 10.1001/jama.299.17.2081

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Week 5 Discussion

Addressing Behavioral Risk Factors

“It is unreasonable to expect that people will change their
behavior easily when so many forces in the social, cultural, and physical
environment conspire against such change” (Kovner and Knickman, p. 139).

When seeking to lessen behavioral risk factors in different
populations, one of the greatest challenges is addressing the systemic issues
within the population that enable the risky behavior to occur in the first
place. Consider the health risks of school-age children not being immunized or
drug users sharing needles. As Dr. Beilenson discussed in the Week 4 media
program, these risky behaviors led to increases in individual and population
health problems. Thus, when planning health prevention programs, it is
important to consider how to effectively address risky behaviors at both the
individual and the population level.

The Discussion this week focuses on the use of the
Population-Based Intervention Model outlined in the course text Health Care
Delivery in the United States, as well as how this model can be applied to
strengthen advocacy programs.

To prepare:

Select one of the behavioral risk factors from the Healthy
Population 2010 Objectives (listed in Table 7.1 on p. 128 of the course text)
that is of interest to you.

Using the Walden Library and other credible websites,
research how this risk factor is affecting your community or state.

With your selected risk factor in mind, review the
information on the Population-Based Intervention Model on pp. 136–140 in the
course text, Health Care Delivery in the United States. In particular, focus on
the concept of downstream, midstream, and upstream interventions. Consider at
least one intervention that could be put into place at each stage.

By Day 3

Post a description of the behavioral risk factor you
selected and how this factor is impacting your community or state. Using the
Population-Based Intervention Model, suggest at least one intervention that
could be put into place at each stage (downstream, midstream, and upstream) to
ensure that a health prevention program addressing the behavioral risk factor
would have a greater chance at succeeding. Justify why each intervention you
identified would be effective.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different
days in one or more of the following ways:

Ask a probing question, substantiated with additional
background information, evidence, or research using an in-text citation in APA
format.

Share an insight from having read your colleagues’ postings,
synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional
research.

Make a suggestion based on additional evidence drawn from
readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional
insights or contrasting perspectives based on readings and evidence.

Reference:

Kovner, A. R., & Knickman, J. R. (Eds.). (2011). Health
care delivery in the United States (10th ed.). New York, NY: Springer
Publishing.

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entering your message. Then click on the Submit button to post your message.

Week 6 Discussion

Improving Quality

Improving the quality of health care delivery and patient
safety continues to be a political concern and has been at the heart of reform
issues for many years. The American Nurses Association (ANA) and the Institute
of Medicine (IOM) have increased awareness of health care quality and safety
issues, as well as advocated for health care reform. The documents featured at
the ANA and IOM websites listed in this week’s Learning Resources focus on many
of the current issues surrounding quality and safety in the health care
industry.

To prepare:

Review this week’s Learning Resources, focusing on the Six
Aims for Improvement presented in the landmark report “Crossing the Quality
Chasm: The IOM Health Care Quality Initiative.”

Consider these six aims with regard to your current
organization, or one with which you are familiar. In what areas have you seen
improvement? What areas still present challenges? As a nurse leader, how can
you contribute to improving the organization’s achievement of these aims?

Select one specific quality or safety issue that is
presenting a challenge in the organization. Consider at least one quality
improvement strategy that could be used to address the issue, as well as which
of the six aims for improvement would then be addressed.

Reflect on your professional practice and your experiences
with inter-professional collaboration to improve quality and safety. How has
inter-professional collaboration contributed to your organization’s efforts to
realize the IOM’s six aims for improving health care? Where has
inter-professional collaboration been lacking?

By Day 3

Post a description of the quality or safety issue you
selected and a brief summary of the impact that this issue has on health care
delivery. Describe at least one quality improvement strategy used to address
this issue. Then explain which of the six “aims for improvement” are addressed
by the strategy. Finally, explain how inter-professional collaboration helps
improve quality in this area.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different
days in one or more of the following ways:

Ask a probing question, substantiated with additional
background information, evidence, or research using an in-text citation in APA
format.

Share an insight from having read your colleagues’ postings,
synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional
research.

Make a suggestion based on additional evidence drawn from
readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional
insights or contrasting perspectives based on readings and evidence.

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entering your message. Then click on the Submit button to post your message.

Week 7 Discussion

Health Care Policy

In this week’s media presentation, Dr. Trautman, Dr.
Wakefield, and Ms. Coyle discuss how public policies initiated at the national
or state level ultimately influence what occurs at the institutional and local
level of nursing practice and health care delivery. Health care policy usually
is developed to address health care cost, quality, or access, or a combination
of the three. Due to the nature of their interaction with patients, nurses are
well situated to be effective, knowledgeable advocates for their patients.

In this week’s Discussion, you will examine how current
policies impact how you as a nurse provide health care. You will then select an
issue of interest and determine how you could advocate for policy in that area.

To prepare:

Select one public policy that currently is impacting you and
your practice. Consider the following:

What health care driver was the policy designed to address:
cost, quality, access, or a combination?

Does the policy appear to be achieving its intended results?
On what data are you basing your assumption?

What have been the effects (adverse or positive) of this
policy on health care cost, quality, and access?

How is this policy affecting your nursing practice?

Next, select a health care issue—something you see or
experience on a daily basis—about which you would like to influence a practice
change through the policy process.

Review the Learning Resources, focusing on Kingdon’s Model.
How would you utilize this model to guide your policy development?

By Day 3

Post a brief description of a public policy that is having
an impact on your practice; summarize your analysis of the policy using the
bulleted list above as a guide. Then, summarize the issue you would like to
influence though a change in public policy, and outline how you would utilize
Kingdon’s Model to guide your policy development.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different
days in one or more of the following ways:

Ask a probing question, substantiated with additional
background information, evidence, or research using an in-text citation in APA
format.

Share an insight from having read your colleagues’ postings,
synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional
research.

Make a suggestion based on additional evidence drawn from
readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional
insights or contrasting perspectives based on readings and evidence.

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entering your message. Then click on the Submit button to post your message.

Week 8 Discussion

Nurses as Health Advocates

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

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

To prepare:

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

Consider the multiple health care needs of returning
veterans and their families.

By Day 3

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

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different
days in one or more of the following ways:

Ask a probing question, substantiated with additional
background information, evidence, or research using an in-text citation in APA
format.

Share an insight from having read your colleagues’ postings,
synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings
from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional
research.

Make a suggestion based on additional evidence drawn from
readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional
insights or contrasting perspectives based on readings and evidence.

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entering your message. Then click on the Submit button to post your message.

Week 9 Discussion

Legal and Ethical Conduct

As emphasized in this week’s media presentation, all nurses
need to be familiar with the laws and regulations that govern their practice:
their state’s Nurse Practice Act, ANA’s Nursing: Scope and Standards of
Practice, specialty group standards of practice, etc. In addition, basic
ethical principles guide nurses’ decision-making process every day. ANA’s Code
of Ethics and ANA’s Social Policy Statement are two important documents that
outline nurses’ ethical responsibilities to their patients, themselves, and
their profession. This said, there is a dilemma: The laws are not always
compatible with the ethical positions nurses sometimes take. This week’s Discussion
focuses on such a dilemma.

To prepare:

Review this week’s Learning Resources, focusing on the
information in the media presentation about the relationship between the law
and ethics.

Consider the ethical responsibility of nurses in ensuring
patient autonomy, beneficence, non-malfeasance, and justice.

Read the following scenario:

Lena is a community health care nurse who works exclusively
with HIV-positive and AIDS patients. As a part of her job, she evaluates new
cases and reviews confidential information about these patients. In the course
of one of these reviews, Lena learns that her sister’s boyfriend has tested HIV
positive. Lena would like to protect her sister from harm and begins to
consider how her sister can find out about her boyfriend’s health status.

Consult at least two resources to help you establish Lena’s
legal and ethical position. These resources might include your state’s Nurse
Practice Act, the ANA’s Code of Ethics, ANA’s Nursing: Scope and Standards of
Practice, and internal or external standards of care.

Consider what action you would take if you were Lena and why.

Determine whether the law and the ANA’s standards support or
conflict with that action.

By Day 3

Post a description of the actions you would take in this
situation, and why. Justify these actions by referencing appropriate laws,
ethical standards, and professional guidelines.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different
days in one or more of the following ways:

Ask a probing question, substantiated with additional
background information, evidence, or research using an in-text citation in APA
format.

Share an insight from having read your colleagues’ postings,
synthesizing the infor