Even though the quality of health care in the United States has been improving over the years, several health disparities still exist. There are disparities in the prevalence of diabetes among different populations. Type 2 diabetes mellitus is more likely to affect individuals from minority populations. Minority populations make up 25% of the adults with diabetes mellitus in the US (Kahn et al., 2019). Asian Americans, Hispanic/Latino Americans, and African Americans are at a high risk of developing type 2 diabetes mellitus.
Several measures have been put in place to reduce diabetes health disparities. For instance, the National Diabetes Prevention Program has been crucial in helping individuals with prediabetes delay or prevent type 2 diabetes. Different ethnic and racial minority groups have been enrolling in the program, thus helping reduce the prevalence of type diabetes among the populations. While working with a lifestyle coach, the participants of the program learn to cope with stress, be physically active, and make better food choices. These practices help in preventing the development of type 2 diabetes mellitus.
Since the prevalence of type 2 diabetes in Native Americans is 2 to 3 times that of whites, programs have been initiated to reduce the prevalence of diabetes in this population. The Native Diabetes Wellness Program is one of the programs that aims at preventing type 2 diabetes in Native Americans by honoring a balance between cultural practices and Western science in the Indian country (DeBruyn et al., 2020). The program promotes physical activity and healthy eating among children by developing a series of colorful books.
Moreover, national diabetes quality improvement initiatives have played a key role in reducing the disparities in the prevalence of diabetes. For instance, some of the deficiencies in health care have been addressed through the Diabetes Quality Improvement Project (DQIP). DQIP is a collaborative effort of health services organizations, insurance organizations, diabetes organizations, and diabetes health care providers. It allows the collaboration of different healthcare providers and organizations in preventing diabetes.
All in all, several measures have been put in place to address the health disparities in diabetes. By allowing individuals from minority groups to enroll in the program, the National Diabetes Prevention Program has played a key role in preventing type 2 diabetes. The Native Diabetes Wellness Program mainly targets the prevention of diabetes among Native Americans.
References
DeBruyn, L., Fullerton, L., Satterfield, D., & Frank, M. (2020). Integrating culture and history to promote health and help prevent type 2 diabetes in American Indian/alaska native communities: Traditional foods have become a way to talk about health. Preventing Chronic Disease, 17, 114. https://doi.org/10.5888/pcd17.190213
Kahn, H. S., Gregg, E. W., Fujimoto, W. Y., & Imperatore, G. (2019). Prevalence of Diabetes by Race and Ethnicity in the United States, 2011-2016. Jama Network, 30341(24), 23892398. https://doi.org/10.1001/jama.2019.19365
Examine Healthy People 2020 health promotion and disease prevention objectives. Identify a health disparity and research this topic; how is it being addressed at both the local and national level?
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Identify ethical dilemmas encountered in professional nursing practice:
Nurses face many medical dilemmas in their nursing practice. Nurses must be guided by ethical principles to solve these dilemmas. This course has taught me that it is inevitable that a nurse will encounter ethical dilemmas in their daily practice. I have learned that to handle these challenging situations, I can rely on the ANA Nurses Code of Ethics to guide me in these challenging times. This course has taught me the importance of ensuring informed consent in nursing care. Informed consent ensures that the patients and their families have been given complete information to make an informed decision (Axson et al., 2017).
Describe the ethical theories and principles influencing healthcare decisions.
This course has enabled me to learn about the ethical theories which affect decision-making in healthcare. These theories include Kantian absolutism and moral relativism, among others (Amer, 2019). I have learned of the ethical principles affecting decision-making in healthcare. There are four such principles. Autonomy respects the patients ability to make informed consent concerning their treatment (Amer, 2019). The principle of beneficence ensures that the healthcare professional provides care intended to bring positive outcomes (Amer, 2019). The principle of nonmaleficence ensures that healthcare providers do not intentionally cause harm to patients (Amer, 2019). The final principle is justice, which ensures fairness and equity in treatment (Amer, 2019)
Explain the inter-dependency of genetics, genomics, and ethics in nursing care.
There are a lot of controversies surrounding the use of genomics in the modern. I have learned that these controversies have also spilled to the healthcare delivery industry. This competency has enabled me to learn of the ethical controversies that surround genetic data. An example is how genetic data for individuals with a risk of developing genetic information can be denied medical insurance. I learned of this when I completed the assignment that our instructor gave. I believe that it is the duty of the nurse to uphold the integrity of the patients genetic information to ensure there is fairness and equity when offering nursing care.
Describe the principles of genetics and genomics.
Genetics is essential to the human race. This course has given me the opportunity to research and understand more about genetics and genomics. Genetics is a topic that interests me a lot, and it is something that I may consider in my future career. There are four main principles in genetics. Dominance principle, the principle of paired factors, independent assortment law, and the law of segregation. The principle that intrigued me the most was the independent law of assortment. This law describes how genes separate from one another during the development of sex cells (Veller et al., 2019).
Differentiate the legal and professional policies influencing healthcare decisions.
Nursing is a science that cares for individuals. It must, however, operate within the confines of the law when providing holistic care to people. This course has enabled me to understand the different laws which govern the healthcare profession. The policies include the scopes of practice by the different nursing boards, ACA, HIPAA, HITECH, and abortion-related laws. This has taught me that there are legal ramifications for practicing outside the confines of the law. It is thus critical to have an understanding of the policies that govern the profession.
Design nursing care strategies that incorporate genetic and genomic risk factors
Nursing care must incorporate all risk factors when managing patients. This course has enabled me to learn that nurses can use genomics in screening, diagnosis, and monitoring treatment to ensure positive patient outcomes. Nurses can get generational information from patients to enable them to diagnose and treat patients. They can incorporate genomics into information technology to identify patients at risk of developing genetic conditions. Genomics is an essential part of healthcare, and I will incorporate genomics into nursing models to offer quality nursing care.
References
Amer, A. B. (2019). Understanding the ethical theories in medical practice. Open Journal of Nursing, 09(02), 188-193. https://doi.org/10.4236/ojn.2019.92018
Axson, S. A., Giordano, N. A., Hermann, R. M., & Ulrich, C. M. (2017). Evaluating nurse understanding and participation in the informed consent process. Nursing Ethics, 26(4), 1050-1061. https://doi.org/10.1177/0969733017740175
Veller, C., Kleckner, N., & Nowak, M. A. (2019). A rigorous measure of genome-wide genetic shuffling that takes into account crossover positions and Mendels second law. Proceedings of the National Academy of Sciences, 116(5), 1659-1668. https://doi.org/10.1073/pnas.1817482116
Identify ethical dilemmas encountered in professional nursing practice.
Describe the ethical theories and principles influencing healthcare decisions.
Explain the interdependency of genetics, genomics, and ethics in nursing care.
Competencies Reflection
Describe the principles of genetics and genomics.
Differentiate the legal and professional policies influencing healthcare decisions.
Design nursing care strategies that incorporate genetic and genomic risk factors.
Four approaches were deployed in the diagnosis procedure: physical examination, laboratory tests, psychiatric evaluation, and DSM-5. In physical examination, a physical exam was administered through a variety of questions on the patients physical health (Fritz et al., 2017). In some instances, depression is associated with an underlying physical health problem. In the lab, blood samples were taken, and a complete blood test was carried out to test the functioning of thyroids (Fritz et al., 2017). In psychiatric evaluation, several mental health questions were administered to the client to determine her symptoms, behavior patterns, and feelings. As the American Psychiatric Association proposed, the Diagnostic and Statistical Manual of Mental Disorders is deployed by medical practitioners.
The diagnosis tests indicated signs of depression. The patient reported unusual restlessness. She was also worried about possible events that could occur. The client exhibited increased energy and elevated self-esteem. Other behavioral habits determined after the diagnosis were high levels of nervousness. The client also faced difficulties in paying attention and concentrating. The blood tests indicated hypothyroidism. This could be perceived as a consequence of an underactive thyroid gland (Staudt et al., 2019). The test outcome is popular among many people with depression.
Differential Diagnosis
Bipolar disorder is one of the most prevalent mental complications in the United States and across the world. It is characterized by the occurrence of fluctuation in energy and mood. According to previous research studies, bipolar disorder is genetic. Many young people worldwide suffer the detrimental impacts of bipolar disorder, such as cognitive impairment (Grande et al., 2016). Many patients diagnosed with bipolar disorder exhibit other underlying comorbidities, which include physical injuries or psychiatric complications (Grande et al., 2016). Bipolar disorder is associated with increasing cases of suicide among young people. About 20% of people diagnosed with bipolar disorder commit or attempt suicide (Mondimore, 2014).
The other mental health complication with a significant impact on cognitive function is a generalized anxiety disorder. This mental health complication is associated with symptoms such as unnecessary worry linked to anticipated events (Lader, 2015). Many individuals with generalized anxiety disorder report a variety of symptoms, including fatigue, sleeping difficulties, irritability, and challenges in concentration (Lader, 2015). Some patients also experience tremors. Mental health professionals have an obligation to advise the patients on the possible triggers of the general anxiety disorder and recommend how the symptoms can be efficiently managed.
The most common approach taken in the treatment of generalized anxiety disorder is the use of cognitive-behavioral therapy. Patients suffering from breathing difficulties are offered therapist programs that enable them to relax through deep breathing, especially during hyperventilation (Kaczkurkin&Foa, 2015).
Major Depressive Disorder comprises another mental complication that impacts cognitive functioning. Common symptoms reported by patients with major depressive disorder include loss of interest, sleeping complexities, impaired cognitive functioning, and decreased appetite. Women are twice as vulnerable to major depressive disorder compared to their male counterparts (Otte et al., 2016). Treatment aims to reduce irritability among clients and increase levels of concentration.
The most common approach taken in the treatment of patients diagnosed with major depressive disorder is the integration of psychotherapy antidepressants. Mental health professionals have an obligation to determine whether one method is sufficient or whether the integration of the two would be more effective depending on the patients characteristics and diagnosis results. In many instances, antidepressants are the most frequently used. In this case study, an ideal approach to treatment is the use of cognitive-based therapy. A variety of studies indicate a high rate of success for techniques such as behavioral intervention in problem-solving and activating behavior among patients with Major Depressive Disorder (Young, Rygh, Weinberger, & Beck, 2014).
Reflection
After responding to the examination questions from the mental health professional, the patient reported instances of sexual assault and sexual abuse. The client has been a victim of sexual abuse and sexual assault from a family member as well as from one stranger they had met on social media platforms. The client has indulged in the use of drugs such as marijuana. Over the past three days, the client reported a lack of sleep. Since the clients boyfriend ended their relationship, the client has suffered depression for a duration of approximately eight months. The client has had a long history of feelings of depression since the age of eighteen. Failure of the client to adhere to prescribed medication poses a challenge in administering treatment to the patient in the case study.
The main objective is to treat manic episodes and depression and stabilize the clients mood. Medication will be administered as the first form of treatment. The client will also be put under regular cognitive-based therapy to boost her cognitive functioning. The cognitive therapy strategy will help to serve where the patient becomes non-compliant with prescribed medication.mental health professionals must equip the client with the knowledge to enable them to detect changes in mood and behavior transition in efforts to increase the quality of life ((Young &Fristad, 2015).
References
Fritz, K., Russell, A. M., Allwang, C., Kuiper, S., Lampe, L., & Malhi, G. S. (2017). Is a delay in the diagnosis of bipolar disorder inevitable? Bipolar disorders, 19(5), 396-400.
Staudt Hansen, P., Frahm Laursen, M., Grøntved, S., Puggard Vogt Straszek, S., Licht, R. W., & Nielsen, R. E. (2019). Increasing mortality gap for patients diagnosed with bipolar disorderA nationwide study with 20 years of follow?up. Bipolar disorders, 21(3), 270- 275.
This report presents an evaluation of the data contained in the Mercy Centers Public Health Dashboard Diabetes dashboard. The evaluation identifies the shortcomings of the organization and gives a proposal of the improvement needed.
Evaluation of Dashboard Metrics
The evaluation of the Mercy Centers Public Health Dashboard Diabetes revealed metrics of concern regarding diabetes management in the organization. The dashboard reveals that there has been a decline in the number of tests done to monitor the levels of HgbA1c in patients over the last three quarters of 2019 (Villa Health, n.d.). In 2018, the tests conducted in the four quarters were 1, 11, 23, and 87, respectively. In the first quarter of 2019, 123 tests were conducted (Villa Health, n.d.). Thereafter, they declined to 32, 13, and 6 tests in the second, third and fourth quarters, respectively.
The other underperformance in the metrics is observed in foot examinations. In 2018, the number of quarterly foot examinations was 2, 5, 27, and 48, respectively (Villa Health, n.d.). This reflects an increase in the exams over the first year. However, in 2019, a decline in the number of foot exams was noted in the second, third, and fourth quarters. The tests reported were 73, 62, 7, and 3, respectively, in the quarters of 2019.
The other metrics that raise concern are the number of eye exams and the data on new cases of diabetes. There are fluctuations in the number of eye exams over the two years. The number of eye exams over the eight quarters of the two years is 4, 16, 7, 33, 41, 28, 16, and 27 (Villa Health, n.d.). The fluctuations raise concerns even though the values in the last two quarters of 2019 are higher than a foot and HgbA1c exams. Data on the new cases of diabetes mellitus does not provide a comparison with the previous quarters of the two years (Villa Health, n.d.). This limits the possibility of creating a comparison and determining the impact of the data.
In the State of Minnesota, data exists on the number of tests conducted on diabetics aged 40 years and above. In 2018, about 78.5 percent of diabetics had eye exams, 80.9 percent had foot exams, and 75.7 had measurements of their HgbA1c levels (Report, 2020). In 2019, the numbers increased to 78.7, 81.9, and 75.8 for eye, foot, and measurements of HgbA1c levels, respectively. National data on diabetics aged 40 years and above revealed the percentage of the population who conducted the tests. In 2018, 75, 62, and 67 percent of the population received HgbA1c, eye, and foot exams, respectively (Report, 2020). In 2019, the percentages reported were 75.2, 62.8, and 68 for HgbA1c, eye, and foot exams, respectively.
The Mercy Centers Public Health Dashboard Diabetes only provides data on the number of diabetics in the last quarter of 2019. The data in the last quarter form the basis of comparison with the State and Federal governments. Based on this data, the percentage of the population who have received the tests is 6 percent, 0.7 percent, and 1.5 percent for eye exams, foot exams, and HgbA1c, respectively (Villa Health, n.d.). Therefore, the number of eye exams, foot exams, and HgbA1c tests performed at Mercy Medical Center were below those set by the State and Federal governments.
The few tests have a negative implication on the well-being of diabetic patients. Diabetic complications such as retinopathy and foot ulcers are most likely to occur and go unnoticed. This is associated with a poor prognosis of the disease. The number of foot and eye exams on diabetic patients should be increased. This will facilitate the early detection of diabetic complications. Early detection enables prompt initiation of treatment. The values from the measurements of Hgb1Ac help to monitor the progress of treatment in diabetics. High values indicate poor blood sugar control.
Additional information that could improve the evaluation is data on the number of diabetics in 2018 and 2019. The Mercy Centers Public Health Dashboard Diabetes provides data for the last quarter of 2019. It doesnt contain data for 2018 and the first three quarters of 2019. This limits the comparison with the State and Federal governments, whose data reflects all quarters of the two years, 2018 and 2019.
Analysis of Challenges in Achieving Acceptable Performance.
The main challenges facing the organization are the lack of a policy that requires mandatory follow-up of diabetic patients and an inadequate number of healthcare providers. The health care facility should have a policy on the care of diabetic patients. An example of an effective policy would be mandatory follow-ups of all diabetic patients enrolled in the facility. The policy should also focus on fulfilling the benchmarks set by the State and Federal governments. The policy should direct all healthcare workers to monitor all diabetic patients closely. Monitoring entails performing regular eye exams, foot exams, measurements of Hgb1Ac, and other screening procedures (Pickens et al., 2018). The number of tests and screenings performed should correspond with the number of patients in the facility. The lack of such a policy leads to underperformance in conducting screening and tests. Furthermore, the lack of a policy that requires the fulfillment of state and federal benchmarks contributes to underperformance. Healthcare workers in such settings are not motivated because they dont work towards a common goal. Therefore, underperformance in the metrics is recorded.
The problem of an inadequate number of healthcare providers can also contribute to underperformance. Healthcare providers such as nurses, physicians, and pharmacists are actively involved in patient monitoring. Healthcare providers in understaffed facilities are overwhelmed by the number of patients (Gardner et al., 2019). This creates burnout and reduces their productivity. This can contribute to the decrease in the number of foot exams, measurements of Hgb1Ac, and fluctuations in the eye exams observed in the health care facility. In contrast, a facility that is adequately staffed has a high ratio of healthcare providers to patients. The healthcare providers in these facilities make regular patient follow-ups. The performance of such facilities is better compared with those that are understaffed.
Specific Target for Improvement
Based on the data from Mercy Centers Public Health Dashboard Diabetes. The number of foot exams and measurements of Hgb1Ac has declined over the last three quarters of 2019. Fluctuations were noted in the number of eye exams. A comparison with the data from the State and Federal governments reveals an underperformance in all three metrics. Therefore, a strategy that leads to an improvement in the number of foot exams, Hgb1Ac measurements, and eye exams is the desired action that should be taken.
Underperformance in the number of foot exams increases the risk of development and a poor prognosis of diabetic foot complications. Diabetic foot is a microvasculature complication (Netten et al., 2020). It can lead to the development of ulcers and increase the number of amputations. Foot exams help to identify complications in their early stages. Early identification by conducting more regular exams enables the initiation of treatment and foot care (Netten et al., 2020). Therefore, the number of foot exams should be increased and be performed consistently to avert diabetic foot complications.
Eye exams are important for all diabetic patients. They enable the identification of diabetic retinopathy, a microvascular complication. The complication is characterized by blurred vision, floaters, and complete blindness (Zie et al., 2020). Conducting regular exams for all diabetic patients enables the identification of these complications and the initiation of treatment. This can help to improve the prognosis of the disease.
Hgb1Ac (glycated hemoglobin) helps to monitor the progress of diabetes treatment. High levels of Hgb1Ac indicate poor control of blood sugar, hence an increased risk of developing diabetic complications. The normal levels should be between 4 and 5.6 percent (Ceriello, 2020). Therefore, all diabetic patients should have their Hgb1Ac levels regularly monitored to determine their response to treatment and prevent the likelihood of developing macrovascular and microvascular complications.
Ethical and Sustainable Recommended Action
To address the underperformance, two interventions should be used. A policy that guides the routine operations of healthcare providers should be established. The second strategy is patient education on the importance of regular eye exams, foot exams, and measurements of Hgb1Ac. The policy should enforce mandatory follow-ups of all diabetic patients enrolled in the facility. It should also focus on fulfilling the benchmarks set by the State and Federal governments. Patients should be educated on the importance of visiting the facility regularly for routine screening and checkups.
Stakeholders include all healthcare providers and the administration of the hospital. The hospital administration should be involved in policy formulation. Healthcare providers should understand that there is underperformance in the metrics and there is a need for change. Thereafter, healthcare providers should uphold the policy and ensure patient care delivery is efficient. The other stakeholders are patients. Patients are key stakeholders because they work in concert with healthcare providers to ensure that all tests are performed as scheduled.
Healthcare providers should incorporate healthcare ethics when fulfilling the policy. They should uphold non-maleficence, beneficence, justice, and respect for autonomy. Justice will ensure that the screening and tests are done equally regardless of the patients background and beliefs (Gillon, 2015). Upholding the policy fulfills the provisions of non-maleficence and beneficence because it is aimed at improving the well-being of the patient and averting any harm (complications). Patient autonomy should also be respected.
The recommendations fail to address the problem of an inadequate number of healthcare providers. However, the formulation of a policy and patient education will make the existing staff work passionately to increase the performance of the metrics. This will lead to an increase in the number of foot exams, Hgb1Ac tests, and eye exams.
References
Vila Health. (n.d.). Dashboard and Health Care Benchmark Evaluation.
Ceriello, A. (2020). Glucose Variability and Diabetic Complications: Is it Time to Treat? Diabetes Care, 43(6), 11691171. https://doi.org/10.2337/dci20-0012
Gardner, R. L., Cooper, E., Haskell, J., Harris, D. A., Poplau, S., Kroth, P. J., & Linzer, M. (2019). Physician Stress and Burnout: The Impact of Health Information Technology. Journal of the American Medical Informatics Association, 26(2), 106114. https://doi.org/10.1093/jamia/ocy145
Gillon, R. (2015). Defending the Four Principles Approach as a Good Basis for Good Medical Practice and, Therefore, for Good Medical Ethics. Journal of Medical Ethics, 41(1), 111116. https://doi.org/10.1136/medethics-2014-102282
Pickens, C., Pierannunzi, C., Garvin, W., & Town, M. (2018). Morbidity and Mortality Weekly Report Surveillance for Certain Health Behaviors and Conditions Among States and Selected Local Areas-Behavioral Risk Factor Surveillance System, United States, 2015. Morbidity and Mortality Weekly Report, 67(9).
Report, N. D. S. (2020). National Diabetes Statistics Report. National Diabetes Statistics Report, 2.
Netten, J. J., Bus, S. A., Apelqvist, J., Lipsky, B. A., Hinchliffe, R. J., Game, F., Rayman, G., Lazzarini, P. A., Forsythe, R. O., Peters, E. J. G., Senneville, É., Vas, P., Monteiro-Soares, M., & Schaper, N. C. (2020). Definitions and Criteria for Diabetic Foot Disease. Diabetes/Metabolism Research and Reviews, 36(S1), 16. https://doi.org/10.1002/dmrr.3268
Zie, G., Kerr, Z. Y., & Moore, J. B. (2020). Universal Healthcare in the United States of America?: A Healthy Debate. 17.
PART 1 of 4
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Please see the following attachments:
1. Assignment 1 Instructions
2. Grading Rubric
3. Example Paper
Please use the Distinguished boxes in the Grading Rubric to guide content for paper.
Dashboard Benchmark Evaluation
Hello,
Please see the attached Dashboard file for Villa Health that can be used for metrics if desired.
Cognitive dissonance is the mental discomfort, or disharmony, of your mind that is induced by two conflicting behaviors, attitude, opinion, and belief. (Cherry, 2020). Festingers theory of cognitive dissonance suggests that we all have a need to keep our attitudes and beliefs balanced and consistent to avoid unpleasant feelings of dissonance. An example of this is when you are thinking about doing something, but you have these conflicting thoughts, and you try to justify why you made this decision to do this, such as making a big purchase, traveling during this time, etc. Sometimes, this situation can cause anxiety or stress because you have multiple thoughts that conflict with each other.
When working in a car sales job, a caring salesperson would try to do what they can to reduce dissonance or buyers remorse. Doing this would create a long-lasting relationship and increase the chances of them becoming repeat customers. I believe that being honest and upfront with the customers can help decrease dissonance. When a buyer feels good and confident that they are purchasing the car they want and for a good price, they will have a low chance of dissonance occurring (Sharifi & Esfidani, 2014). I recently was in the car buying search, and my husband and I went to multiple dealerships to see what was best for us. There were moments when we were at a dealership where we felt that the car salesman was trying too hard to create that relationship. When we finally found a car that we loved and was a complete upgrade from what we had before, we certainly didnt think about having buyers remorse.
References
Festinger, L. (1961). The psychological effects of insufficient rewards. American Psychologist, 16(1), 1-11. https://doi.org/10.1037/h0045112
Sharifi, S. S., & Esfidani, M. R. (2014). The impacts of relationship marketing on cognitive dissonance, satisfaction, and loyalty mediating the role of trust and cognitive
Dissonance. International Journal of Retail & Distribution Management, 42(6), 553-575. doi:10.1108/IJRDM-05-2013-0109
What is cognitive dissonance? What role does it play in regard to attitude and/or behavior change? What is the role of external rewards in regard to an attitude change?
Cognitive Dissonance
How might a new car salesperson use what he/she knows about cognitive dissonance (sometimes called buyers remorse) to make a customer more content with their purchase (and less likely to want to return their vehicle)?
A PICOT question has five components. It identifies a specific patient population, the intervention used in managing the people, and a comparison to a population that does not receive the intervention. It evaluates the outcome and the time needed to implement the intervention. The PICOT question for my capstone change project: Among patients receiving surgical nursing care, does a low nurse-patient ratio improve recovery rates compared to a high nurse-patient ratio (due to nursing shortage) over five months? A literature review is integral to any research to evaluate how the currently available research supports the question at hand.
A Comparison of Research Questions
Abhicharttibutra et al. (2017) propose three qualitative research questions. How did the Production and Development of Educational Management in Nursing (PIPDEMN) get onto the government agenda? What were the development processes of the PIPDEMN? How was the PIPDEMN implemented? The three research questions seek to identify and describe the process of policymaking used by the Thai government to increase nursing capacity and education quality. This helps to identify the key stakeholders involved in policy formulation. When nurses are affected, the problem of nursing shortage is likely to be addressed and lead to the improvement of the quality of services provided.
Buerhaus et al. (2017) propose a hypothesis on the challenges nurses face in the USA. Registered nurses will face four main problems in the next 20 years (Buerhaus et al., 2017). The problems include an ageing task force, the uncertainty of health care reform, the shortage and uneven distribution of physicians, and an increased number of retirees. This has led to a decrease in the quality of services delivered by nurses. The research question proposed by Drennan & Ross (2019): What is known about current nurse workforces and shortages, and what can be done to forestall such shortages? The question seeks to address the problem of nursing shortage that has been reported.
Haryanto (2019) proposes a hypothesis that states that nursing shortage is a global challenge. The challenge has led to burnout, stress, and a reduction in the productivity of the workforce. According to Zhang et al. (2018), the demand for registered nurses will exceed the supply from 2016 to 2030. This hypothesis reveals that the nursing shortage problem will worsen in the future. This suggests that the issue of decreased service delivery quality is likely to be compounded. Weaver et al. (2018) hypothesised that the nursing shortage creates a burden of care for families whose children receive palliative care. The nursing shortage has a time, economic and psychological impact on the families of children receiving palliative care.
According to Scheffler & Arnold (2019), the demand for doctors and nurses will increase by 2030, compounding the nursing shortage problem. Mar? et al. (2019) formulate a research question to determine the causes of nursing shortage and the impact of the existing policies. This can help address the problem by ensuring the best approaches are adopted.
A Comparison of Sample Populations
The study by Abhicharttibutra et al. (2017) focuses on the informants who were initially involved in the policymaking process of PIPDEMN. Buerhaus et al. (2017) target the nursing workforce in the USA, whereas Drennan & Ross (2019) review published documents from international organizations. The sample for the study conducted by Haryanto (2019) is published papers such as the fact sheet of the American Association of College of Nursing.
Mar? et al. (2019) analyze national listings and strategic documents for nursing policy in Poland. Scheffler & Arnold (2019) target 32 countries in the Organization for Economic Cooperation and Development. Weaver et al. (2018) target families of children receiving inpatient pediatric palliative care consultation during admission. Zhang et al. (2018) performed a linear regression analysis of national listings of demand and supply of nurses in the 50 states of the USA.
A Comparison of the Limitations of the Study
Drennan & Ross (2019) note that international policies fail to consider nurses demographic profiles, career paths, and remuneration. Haryanto (2019) and Drennan & Ross (2019) reported a similar limitation: limited access to data. The end is attributed to insufficient published documents from national and international organizations. Time constraints were written by Abhicharttibutra et al. (2017). Time constraints hindered access to all critical informants targeted by the study. Weaver et al. (2018) reported a small sample and noted that the impact of nursing shortage may differ across the USA. Zhang et al. (2018) note that the study excluded the possibility of foreign nurses entering the country. This can lead to an underestimation of the supply of registered nurses.
Conclusion and Recommendations
The nursing shortage is a global problem that should be addressed promptly. A review of the research literature identified research questions that seek to implement policies that address the issue. The primary study limitations placed during the literature review are time constraints, ends in the sample size, limited access to data, and failure to consider the remuneration and demographics of nurses.
Several recommendations have been proposed. Nurses should be actively involved in policy formulation to address the nursing shortage. Scholarships and incentives should be provided to qualified nursing applicants. The number of training nursing training institutions should be increased to accommodate all qualified applicants. A data-informed, country-specific model of the routes of supply and demand should be used to address the nursing shortage. It requires evidence-informed policy and resource allocation at national, sub-national, and organisational levels. Hospital patient care unit managers and human resource officers should be involved in identifying the causes of the main problems of the workforce and informing both the federal and state governments.
References
Abhicharttibutra, K., Kunaviktikul, W., Turale, S., Wichaikhum, O. A., & Srisuphan, W. (2017). Analysis of a Government Policy to Address Nursing Shortage and Nursing Education Quality. International Nursing Review, 64(1), 2232. https://doi.org/10.1111/inr.12257
Buerhaus, P. I., Skinner, L. E., Auerbach, D. I., & Staiger, D. O. (2017). Four Challenges Facing the Nursing Workforce in the United States. Journal of Nursing Regulation, 8(2), 4046. https://doi.org/10.1016/S2155-8256(17)30097-2
Drennan, V. M., & Ross, F. (2019). Global Nurse Shortages The Facts, the Impact, and Action for Change. British Medical Bulletin, 130(1), 2537. https://doi.org/10.1093/bmb/ldz014
Mar?, M., Bartosiewicz, A., Burzy?ska, J., Chmiel, Z., & Januszewicz, P. (2019). A Nursing Shortage A Prospect of Global and Local Policies. International Nursing Review, 66(1), 916. https://doi.org/10.1111/inr.12473
Scheffler, R. M., & Arnold, D. R. (2019). Projecting Shortages and Surpluses of Doctors and Nurses in the OECD: What Looms Ahead. Health Economics, Policy, and Law, 14(2), 274290. https://doi.org/10.1017/S174413311700055X
Weaver, M. S., Wichman, B., Bach, S., Schroeder, D., Vail, C., Wichman, C., & MacFadyen, A. (2018). Measuring the Impact of the Home Health Nursing Shortage on Family Caregivers of Children Receiving Palliative Care. Journal of Hospice and Palliative Nursing, 20(3), 260265. https://doi.org/10.1097/NJH.0000000000000436
Zhang, X., Tai, D., Pforsich, H., & Lin, V. W. (2018). United States Registered Nurse Workforce Report Card and Shortage Forecast: A Revisit. American Journal of Medical Quality, 33(3), 229236. https://doi.org/10.1177/1062860617738328
I have attached my PICOT question paper and the Literature Eval table paper to help. Let me know if you need anything else. Also, are you familiar with this assignment? Thanks again.
A PICOT Question
While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone project change proposal, the literature review enables students to map out and move into the projects active planning and development stages.
A literature review analyzes how current research supports the PICOT and identifies what is known and not in the evidence. Students will use the information from the earlier PICOT Question Paper and Literature Evaluation
Table assignments to develop a 750-1,000 word review that includes the following sections:
Title page
Introduction section
A comparison of research questions
A comparison of sample populations
A comparison of the limitations of the study
A conclusion section incorporating recommendations for further research
Prepare this assignment according to the guidelines in the APA Style Guide in the Student Success Center. An abstract is not required.
The American Association of Colleges of Nursing (AACN) is the major force behind excellence and innovation in nursing education, research, and practice. The AACN openly discussed how they set agendas every year. The AACN adopted a new nursing education framework, The Essentials: Care Competencies for Professional Nursing Education, as an update to the previously existing framework, which has been in place since 1986 (American Association of Colleges of Nursing (AACN), 2021). The implementation of the new framework will lead to substantial changes to the nursing curriculum, learning and assessment activities, and transition to practice with significant implications for health and nursing regulation (Giddens et al., 2022). The Essential Framework defines the quality of nursing education and will continuously guide the AACN in setting the associations yearly agenda. As per AACN, the Essentials framework is a bridge towards filling the transitional gap between nursing education and nursing practice. It guides the AACN in its policy and advocacy role to push for regulations that improve the quality of education by integrating education and practice to support the transition from education to the nursing role in clinical settings.
Through the new Essentials, AACN determines priority areas and focuses its policy and advocacy agenda on such areas to support regulatory bodies and ensure sound policies are formulated and implemented. For instance, the AACN has set its priorities for academic nursing in its 2023-2024 federal policy agenda as per the core policy values of sustainability, inclusivity, and innovation set by the new Essentials. The set priorities for the 2023-2024 policy agenda include advancing higher education, pursuing transformative research, developing a robust workforce, and redefining models of care. Therefore, the AACN sets agendas for every year based on priority areas of need that can significantly advance the nursing profession to improve health care to meet prevailing needs.
References
American Association of Colleges of Nursing (AACN). (2021). The Essentials: Core Competencies For Professional Nursing Education.
Giddens, J., Douglas, J. P., & Conroy, S. (2022). The Revised AACN Essentials: Implications for Nursing Regulation. Journal of Nursing Regulation, 12(4), 1622. https://doi.org/10.1016/S2155-8256(22)00009-6
One of the most revolutionary healthcare delivery is accountable care organizations. Responsible care organizations (ACOs) are healthcare providers such as nurses, physicians, and hospitals who voluntarily improve care coordination (CMS.gov, 2021). The healthcare providers establish agreements with payers. ACOs must meet quality performance standards and reduce healthcare spending by a certain limit set by Medicare to qualify for reimbursements for their cost-saving healthcare services (CMS.gov, 2021). The enactment of the Affordable Care Act (ACA) in 2010 by former President Obama laid the foundation for developing ACOs (Moy et al., 2021). ACOs have been beneficial in achieving quality improvement objectives and reducing healthcare services costs by focusing on population health management.
The best benefits that patients gain from ACOs are low healthcare costs and improved quality of healthcare savings. Healthcare acts like ACA focus on reducing healthcare spending (Moy et al., 2021). ACOs have since focused on reducing the cost of healthcare services. Hospitals and physicians are implementing systems and protocols that ensure efficiency and have lowered healthcare costs. Providers under ACOs are implementing disease prevention strategies and reducing or eliminating unnecessary medical procedures and interventions to get a share of the savings reimbursements from Medicare. In ACOs, there are reduced emergency department visits and hospital admissions. ACO also improves population health management and patient outcomes by developing innovative methods such as disease prevention and wellness promotion, reducing the likelihood of contracting diseases and leading to a healthier population (Wilson et al., 2020). Patients benefit greatly since they have improved healthcare outcomes, get quality medical services, have a broader engagement with healthcare professionals, and reduce out-of-pocket spending.
Moy, H. P., Giardino, A. P., & Varacallo, M. (2021, February 14). Accountable care organization. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK448136/
Wilson, M., Guta, A., Waddell, K., Lavis, J., Reid, R., & Evans, C. (2020). The impacts of accountable care organizations on patient experience, health outcomes, and costs: A rapid review. Journal of Health Services Research & Policy, 25(2), 130-138. https://doi.org/10.1177/1355819620913141
Describe one innovative healthcare delivery model that incorporates an interdisciplinary care delivery team. Explain how this model is advantageous to patient outcomes.
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Agenda Comparison Grid Assignment Template for Part 1 and Part 2
Part 1: Agenda Comparison Grid
Identify the Population Health concern you selected.
Covid-19 pandemic
Describe the Population Health concern you selected.
Covid-19 is an infectious respiratory disease caused by SARS-CoV-2 (Corbella, 2021). This is a new strain of the coronavirus strain that can cause illness in humans. Scientists and healthcare professionals are still learning about this disease. They, however, believe it originated from animals who then infected humans. Covid-19 spreads from human to human through infected air droplets transmitted through coughing or sneezing (Corbella, 2021). Human beings can also get this infection when their hands come into contact with surfaces or hands containing the virus and touch their mouths, nose, or eyes with the same hand (Corbella, 2021). Covid-19 was first reported in Wuhan, China, in 2019, but it has now spread globally. It has adverse health and economic effects. Since its outbreak, it has resulted in many deaths (Corbella, 2021).
Administration (President Name)
Donald Trump
Joe Biden
Explain how each of the two presidential administrations approached the issue.
There were irregular communications that diminished as the pandemic intensified.
There were inconsistencies in the severity of the pandemic. Donald Trump downplayed the severe nature of this pandemic.
There was misinformation- President Trump claimed that hydroxychloroquine could treat Covid-19.
The president shut American borders to prevent the entry of the virus.
The Biden administration has regular communications on the virus. There are thrice-weekly briefings.
The president has a coordinated national response plan. The federal government is in charge of the response.
Biden advocated wearing masks with mayors and governors in charge of this initiative.
Identify the allocations of resources that the current and previous presidents dedicated to this issue.
The president authorized emergency funds to help in resource mobilization.
He signed four emergency spending bills to provide relief for Americans.
They released extra funds to pay healthcare workers, expand COBRA coverage, and reimburse employers when their employees used paid leave benefits.
Part 2: Agenda Comparison Grid Analysis
Using the information you recorded in Part 1: Agenda Comparison Grid, complete the following to document information about the population health/healthcare issue you selected
Administration
Which administrative agency (like HHS, CDC, FDA, OHSA) would most likely be responsible for helping you address the healthcare issue you selected? Why is this agency the most helpful?
The agency that would help the most in this situation is the Centers for Disease Control and Prevention (CDC). The CDC has a critical role in the Covid-19 response. It works full-time to protect the nation and ensure the local and state public health partners have the scientific expertise, guidance, and resources required to respond to COVID-19. The CDC has activated its Emergency Operations Center to provide critical and urgent support. The CDC received extra funding from the government, and it is funding localities, tribes, states, and territories to combat the COVID-19 threat. This CDC emergency funding can be used for contact tracing, surveillance, laboratory testing, diagnostic development, public outreach, health department coordination, vaccine planning and distribution, and education for healthcare workers (CDC, 2021).
How do you think your selected healthcare issue might get on the presidential agenda? How does it stay there?
The selected healthcare issue can reach the presidential agenda due to its far-reaching economic and healthcare consequences. This disease has claimed thousands of lives, led to unemployment, disrupted the economy, and has devastating healthcare effects. This disease must thus be on the presidential agenda since the president took an oath to protect and defend American citizens. Healthcare experts and the presidents advisors can ensure that it stays in the presidential by constantly doing contact tracing and providing the president with facts on how the pandemic affects Americans and strategies that can be implemented to cushion Americans.
Who would you choose to be the entrepreneur/ champion/sponsor (this can be a celebrity, a legislator, an agency director, or others) of the healthcare issue you selected? An example is Michael J. Fox, a champion for Parkinsons disease.
The celebrity I would choose to champion for COVID-19 is Charli D Amelio. She is a TikTok sensation and the most followed person on TikTok. TikTok is a social media platform where individuals can share videos with their followers. This is a viral app that rose to prominence during the pandemic. Miss Charli can serve as a champion and educate the public on the importance of public health strategies such as handwashing, social distancing, and wearing masks to control the spread of COVID-19 (Zhang et al., 2020). She can also educate and encourage the public on vaccinations.
PART 3: Fact Sheet
Covid-19 is a severe healthcare infection that began in Wuhan, China. This disease presents acute symptoms that can cause severe respiratory distress (Corbella, 2021). Scientists are still learning more about this condition. This disease is spread from human to human through air droplets and is transmitted when individuals cough or sneeze. Covid-19 has led to serious health and economic issues. It has caused severe morbidity and mortality. It has also led to the loss of millions of jobs, leading to an increased uninsured population in the United States. This is a severe issue that should have the attention of legislators. Legislators should implement laws and policies to ensure that Americans are protected from the pandemic and appropriate bills to help with vaccination distribution and public health initiatives.
Nurses can be involved in agenda-setting at the local, state, and national levels. Agenda setting can be defined as the problem of moving an issue to the governments attention to allow for consideration of solutions (Milstead & Short, 2017). Nurses can use their knowledge to help in agenda-setting on many issues affecting the healthcare delivery industry and healthcare quality. Nurses are interested in healthcare issues that affect the general public; additionally, they have the knowledge and skills that can be used to implement and evaluate healthcare policies. They can help policymakers to create better public policies. Nurses can help to change practice interventions in the organizations they work in. Nurses can initiate new initiatives that impact healthcare at their organizations. The initiative results can have implications leading to agenda-setting at the national government level (Milstead & Short, 2017).
Moreover, they can apply theoretical frameworks to help them in agenda-setting. They can use these theories to find opportunities to help them move their agendas forward. Nurses can also involve themselves in political activities to help agenda-setting (Milstead & Short, 2017). They can also collaborate with government agencies such as the FDA in agenda-setting.
Milstead, J. A., & Short, N. M. (2017). Health policy and politics (6th ed.). Jones & Bartlett Learning.
Zhang, N., Shi, T., Zhong, H., & Guo, Y. (2020). COVID-19 prevention and control public health strategies in Shanghai, China. Journal of Public Health Management and Practice, 26(4), 334-344. https://doi.org/10.1097/phh.0000000000001202
It may seem to you that healthcare has been a national topic of debate among political leaders for as long as you can remember.
Agenda Comparison Grid
Healthcare has been a policy item and a topic of debate not only in recent times but as far back as the administration of the second U.S. president, John Adams. In 1798, Adams signed legislation requiring that 20 cents per month of a sailors paycheck be set aside for covering their medical bills. This represented the first significant piece of U.S. healthcare legislation, and the topic of healthcare has been woven into presidential agendas and political debates ever since.
As a healthcare professional, you may be called upon to provide expertise, guidance and opinions on healthcare matters as they are debated for inclusion into new policy. You may also be involved in planning new organizational policies and responses to changes in legislation. For all of these reasons, you should be prepared to speak to national healthcare issues making the news.
In this Assignment, you will analyze recent presidential healthcare agendas. You also will prepare a fact sheet to communicate the importance of a healthcare issue and the impact on this issue of recent or proposed policy.
To Prepare:
Review the agenda priorities of the current/sitting U.S. president and at least one previous presidential administration.
Select an issue related to healthcare that was addressed by two U.S. presidential administrations (current and previous).
Consider how you would communicate the importance of a healthcare issue to a legislator/policymaker or a member of their staff for inclusion on the agenda.
Use your Week 1 Discussion post to help with this Assignment.
The Assignment: (1- to 2-page Comparison Grid, 1-page Analysis, and 1-page narrative) with a title page. This is an APA paper. Use 2-3 course resources and at least two outside resources.
Part 1: Agenda Comparison Grid
Use the Agenda Comparison Grid Template found in the Learning Resources and complete Part 1: Agenda Comparison Grid based on the current/sitting U.S. president and the previous president and their agendas related to the population health concern you selected. Be sure to address the following:
Identify and provide a brief description of the population health concern you selected.
Explain how each of the presidential administrations approached the issue.
Identify the allocation of resources that the presidents dedicated to this issue.
Part 2: Agenda Comparison Grid Analysis
Using the information you recorded in Part 1: Agenda Comparison Grid on the template, complete the Part 2: Agenda Comparison Grid Analysis portion of the template by addressing the following:
Which administrative agency (like HHS, CDC, FDA, OHSA) would most likely be responsible for helping you address the healthcare issue you selected, and why is this agency the most helpful for the issue?
How do you think your selected healthcare issue might get on the presidential agenda? How does it stay there?
An entrepreneur/champion/sponsor helps to move the issue forward. Who would you choose to be the entrepreneur/champion/sponsor (this can be a celebrity, a legislator, an agency director, or others) of the healthcare issue you selected, and why would this person be a good entrepreneur/ champion/sponsor? An example is Michael J. Fox, who is a champion for Parkinsons disease.
Part 3: Fact Sheet
Using the information recorded on the template in Parts 1 and 2, develop a 1-page fact sheet that you could use to communicate with a policymaker/legislator or a member of their staff about this healthcare issue. Be sure to address the following:
Summarize why this healthcare issue is important and should be included in the agenda for legislation.
Justify the role of the nurse in agenda-setting for healthcare issues.
The standard of Professional Performance defines the level of competent behavior nursing professionals should have while in their practice areas. The selected Standard of Professional Performance is standard nine, which is communication. The standard requires registered nurses to communicate effectively while in their areas of practice (Harper & Maloney, 2017). While in their care environment, nurses should communicate effectively with other healthcare professionals, the patient, and the patients relatives. Effective communication should entail verbal and nonverbal cues to ensure that interaction with the patient and other medical personnel is professional.
Journal Article
The title of the journal article is Enhancing communication to improve patient safety and to increase patient satisfaction by Burgener Audrey. The article was published on 7 September 2020. The report was found in the PubMed search engine, where key terms related to effective communication in nursing practice were used. The report gives the importance of effective communication in health organizations (Burgener, 2020). According to Burgener (2020), adverse events in health organizations occur due to ineffective communication (Burgener, 2020). Enhancing communication in healthcare improves the safety of patients and their experiences. Improvement of patient care and satisfaction can be achieved through effective and efficient communication (Burgener, 2020). Programs such as education and training of nurses enhance effective communication, which improves the safety of patients and increases the satisfaction of patients.
Commentary
The standard helps in understanding that effective communication is essential in nursing practice. In professional practice, a nurse is involved in activities such as leadership and collaboration, which require effective communication. Thus, effective communication is an essential part of the nursing profession. The standard of communication is relevant in nursing since it improves care quality and ensures patient safety and satisfaction (Baddley, 2018). Effective communication between nurses, other professionals, and the patient reduces medical errors and improves patient outcomes. Communication also allows the sharing of ideas and skills. I would incorporate the standard into my nursing practice through interdisciplinary collaboration. Interaction with other professionals caring for the patient requires effective communication. Attending education and training sessions or seminars on effective communication will also help improve my communication skills.
References
Baddley, D. (2018). Enhancing effective communication among non-verbal patients. Pediatric Nursing, 44(3), 144-146.
Burgener, A. M. (2020). We are enhancing communication to improve patient safety and to increase patient satisfaction. The health care manager, 39(3), 128-132. doi: 10.1097/HCM.0000000000000298
Harper, M., & Maloney, P. (2017). The updated nursing professional development scope and standards of practice. The Journal of Continuing Education in Nursing, 48(1), 5-7.
