6003 Discussion Week 10

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EXAMINING NURSING SPECIALTIES

You have probably seen one or more of the many inspirational posters about decisions. A visual such as a forked road or a street sign is typically pictured, along with a quote designed to inspire.

Decisions are often not so easily inspired. Perhaps you discovered this when choosing a specialty within the MSN program. This decision is a critical part of your plan for success, and you no doubt want to get it right. This is yet another area where your network can help, as well as other sources of information that can help you make an informed choice.

Note: Unless otherwise noted, initial postings to Discussions are due on or before Day 3, and response postings are due on or before Day 6. You are required to participate in the Discussion on at least three different days (a different day for main post and each response). It is important to adhere to the weekly time frame to allow others ample time to respond to your posting. In addition, you are expected to respond to questions directed toward your own initial posting in a timely manner.

 

RESOURCES

Be sure to review the Learning Resources before completing this activity.Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

To Prepare:

Reflect on your decision to pursue a specialty within the MSN program, including your professional and academic goals as they relate to your program/specialization.

BY DAY 3 OF WEEK 10

Post an explanation of your choice of a nursing specialty within the program. Describe any difficulties you had (or are having) in making your choice, and the factors that drove/are driving your decision. Identify at least one professional organization affiliated with your chosen specialty and provide details on becoming a member.

 

Required Readings

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6050 Discussion Teacher reply Week 9

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Reply with 2 references.

Thank you for your post, LaShonda! When analyzing policies, what framing questions should you ask? 

 Dodson

 

 

 

 

 

 

 

THE POST TO repy TO

The Role of the RN/APRN in Policy Evaluation

            The evaluation topic focuses on the effectiveness of expanding Medicaid under the Affordable Care Act. The expansion broadens Medicaid eligibility criteria, to extend coverage to low-income income individuals who were previously ineligible. Medicaid plays a significant role in providing healthcare coverage to vulnerable populations, particularly low-income Americans, pregnant women, children, and people with disabilities. The evaluation aims to assess the impact of Medicaid expansion on access to coverage, health outcomes, and equitable access to affordable, quality healthcare services.

Evaluation Criteria

            The first criterion is increased access to health coverage. The program has improved coverage for low-income Americans, leading to a significant decline in uninsured individuals. According to Centers for Disease Control and Prevention (2018), the rate of uninsured adults decreased from 18.4% to 9.9% between 2013 and 2018 in Medicaid expansion states, while that of uninsured individuals declined from 22.7% in 2013 to 17.5% in 2015 in non-expansion states. The second criterion is improved access to care. Medicaid expansion has improved access to and affordability of quality healthcare services. Studies show that in states with Medicaid expansion, individuals have a high likelihood of having a personal doctor, access to regular care, and increased treatment of chronic conditions (Simon et l., 2017; Gosh et al., 2018). The third criterion is enhanced health outcomes. Studies show that expanding the Medicaid program has improved certain health outcomes, including self-reported health, and surgical outcomes, and reduced rates of preventable hospitalizations (Graves et al., 2020; Loehrer et al., 2018; Brown et al., 2021).

            Social determinants of health, including income, education, and geographic disparities play a significant role in influencing the success of the expanded Medicaid program (Chisolm, 2019). Despite the expansion, income disparities still influence the ability of individuals to access care. Education levels determine individuals’ awareness of the benefits of Medicaid and eligibility criteria, influencing enrollment rates. In the same manner, geographic disparities in healthcare infrastructure affect the accessibility and delivery of services for the expanded Medicaid program.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Brown, E.A., White, B.M., Jones, W.J., Gebregziabher, M., and Simpson, K.N. (2021) Measuring the impact of the Affordable Care Act Medicaid expansion on access to primary care using an interrupted time series approach. Health Res Policy Sys19, 77. https://doi.org/10.1186/s12961-021-00730-0Links to an external site.

Centers for Disease Control and Prevention. (2018). Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2018. Retrieved from https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201905.pdfLinks to an external site.

Chisolm, D. J., Brook, D. L., Applegate, M. S., & Kelleher, K. J. (2019). Social determinants of health priorities of state Medicaid programs. BMC Health Services Research, 19(1). doi:10.1186/s12913-019-3977-5 

Ghosh, A., Simon, K., & Sommers, B. D. (2019). The Effect of Health Insurance on Prescription Drug Use Among Low-Income Adults: Evidence from Recent Medicaid Expansions. Journal of health economics, 63, 64–80. https://doi.org/10.1016/j.jhealeco.2018.11.002Links to an external site.

Graves, J., Hatfield, L., Blot, W., Keating, N., & McWilliams, J. M. (2020). Medicaid Expansion Slowed Rates of Health Decline for Low-Income Adults in Southern States. Health Affairs 39,(1), 67–76.

Loehrer, A., Chang, D., Scott, J., Hutter, M., Patel, V., Lee, J., & Sommers, B. (2018). Association of the Affordable Care Act Medicaid Expansion with Access to and Quality of Care for Surgical Conditions. JAMA Surgery, 153(3).

Simon, K., Soni, A., & Cawley, J. (2017). The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions. Journal of policy analysis and management: [the journal of the Association for Public Policy Analysis and Management], 36(2), 390–417. https://doi.org/10.1002/pam.21972Links to an external site.

 

6050 Discussion Week 9

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Brennan Lacarl 

 

 

Reply #1 with 2 references.

The Affordable Care Act (ACA) is a healthcare reform created to provide affordable health insurance to everyone. It also, “supports medical care delivery methods designed to lower the costs of health care” (Assistant Secretary for Public Affairs (ASPA), 2022).

Policy Evaluation

The ACA has protected more than 133 million people with pre-existing conditions, like cancer, asthma or diabetes, pregnancy, from being denied coverage for their pre-existing condition. It established the Substance Abuse and Mental Health Services Administration (SAMHSA) Office of Behavioral Health Equity, which coordinates efforts to reduce disparities in mental and substance use disorders across populations. It provided $50 million to support further development of the Aging and Disability Resource Center (ADRC) Program, which works to assist individuals in critical pathways, defined as times or places where people make important decisions about long-term care (Assistant Secretary for Public Affairs (ASPA), 2023).

The Criteria to Measure the Effectiveness

The criteria used to evaluate the effectiveness of the ACA includes: “increasing the number of the insured, improving the quality of care, and reducing the costs of health care. (Manchikanti, Helm Ii, Benyamin, & Hirsch, 2017). These three factors prove to display the positive effects of the healthcare program. It was created to give affordable healthcare to everyone at a lower cost.

The Social Determinants

The ACA includes provisions aimed at reducing racial and ethnic health disparities, including an additional $11 billion in funding for community health centers. Nearly two-thirds of the 20 million individuals receiving care at these community health centers are racial and ethnic minorities (Alliance for Health Policy, 2023). Social determinants of health such as poverty, unequal access to health care, lack of education, stigma, and racism are underlying, contributing factors of health inequities. The Centers for Disease Control and Prevention (CDC) is committed to achieving improvements in people’s lives by reducing health inequities (Centers for Disease Control and Prevention, 2019).

 

References

 

Alliance for Health Policy. (2023, May 11). Chapter 7 – Social Determinants of Health | Alliance for Health Policy. https://www.allhealthpolicy.org/sourcebook-chapter/social-determinants-of-health#:~:text=The%20ACA%20includes%20provisions%20aimed,and%20ethnic%20minorities%20(source)Links to an external site..

 

 

Reply #2 with 2 references.

Key Lashawn

The Needle Exchange Program Evaluation

 

 

The main goal of a needle exchange program (NEP) is to prevent HIV and other blood-borne viruses such as Hepatitis B and C in the community by providing sterile syringes and needles to replace used ones. In this regard, the program aims to discourage the re-use of needles among drug users to prevent the spread of disease. Moreover, these infections can lead to costly clinical complications, such as perinatal and fetal problems, and reproductive health issues.  In addition, substance abuse in the community is associated with the spread of sexually transmitted infections (STIs), largely due to the alteration in behavior that results from being under the influence.  As a result, drug abuse is a public health and safety concern. According to Healthy People (2022), complications arising from STIs can be prevented through the promotion of healthy sexual behavior, community capacity building (CCB), and increased access to quality healthcare services. The objectives of Healthy People for preventing HIV include reducing the rate of HIV transmission and new HIV infections among the adult and adolescent population (Healthy People 2020, 2022).  Hence, the NEP aims to reduce HIV and related STDs by increasing the disposal of used needles and syringes among adults and teenagers abusing drugs and allowing them to use sterile alternative injectables.

There are many NEP programs in the U.S. including the Kentucky Harm Reduction and Syringe Exchange (HRSEP) and Indiana Syringe Exchange Program (ISEP). The ISEP program was passed into law in 2015 to permit the creation of SEPs in Indiana communities (Mette et al. 2020). Moreover, non-profit organizations, municipalities, and local health departments operate the SEP program in Indiana. Additionally, the HRSEP allows the exchange of used syringes and hypodermic needles for sterile substitutes by providing guidelines to initiate this program within the Kentucky community. Evaluating the effectiveness of healthcare policies encompasses assessing the social and economic condition of the population including stakeholders (Milstead & Short, 2019). Hence, evaluating NEP programs is important since it helps to determine the health condition of drug users as well as STI transmission rates.

The criteria for measuring the effectiveness of needle exchange programs include monitoring the needle sharing patterns, frequency of needle-reuse, and disposal methods of needles. Moreover, assessing the NEP design features effects such as opening hours and the individual site characteristics. Assessing the rate of needle reuse is very relevant because it shows whether participants have access to clean injection equipment or if they are forced into resorting to using contaminated needles (Centers for Disease Control and Prevention, 2023). Safe needle disposal is another one of the practices that make NEPs effective because safe means for used needles reduce likelihoods such as accidental needle stick injuries or community encounters with discarded ones. Lastly, other methods of measuring the effect of NEP programs include assessing needle distribution and discard among drug users.

The NEP that focuses on STD prevention is affected by several social determinants associated with the policy. Social and economic factors become important because individuals with lower income cannot have easy access to healthcare services, such as needle exchange programs (Centers for Disease Control and Prevention, 2023). For example, individuals who do not possess sufficient funds cannot get harm reduction programs or acquire clean needles. What makes the Needle Exchange Program effective is the structural nature of stigmatization and discrimination. The stigmatization of the drug injectors may be affected by various social ethics relating to drug use and related behavior, which in turn can mediate their likelihood of participating in needle exchange programs (Earnshaw, 2020). Furthermore, the change of government priorities and funded objectives have also impacted on the coverage growth. However, perceptions of social ethics differ from one society to the next, and such differences may make drug injectors feel ashamed, which consequently lowers their willingness to participate in needle exchange programs. In this regard, changing governments’ priorities and goals has also influenced the expansion of topics associated with NEPs. Hence, when these socioeconomic factors are accounted for and addressed, NEPs that aim to prevent STIs and improve community health can work more effectively.

 

 

References

 

Centers for Disease Control and Prevention. (n.d.). Brief 4: Evaluating policy implementation: Step by step – evaluating violence and injury prevention policies. https://www.cdc.gov/injury/pdfs/policy/Brief%204-a.pdfLinks to an external site.

Earnshaw, V. A. (2020). Stigma and substance use disorders: A clinical, research, and advocacy agenda. American Psychologist, 75(9), 1300. https://psycnet.apa.org/record/2020-99903-024Links to an external site.

Healthy People 2020. (2022). Sexually transmitted diseases. https://wayback.archive-it.org/5774/20220413182711/https://www.healthypeople.gov/2020/topics-objectives/topic/sexually-transmitted-diseasesLinks to an external site.

Mette E, Manz J, & Long K. (2020). Syringe Services Programs. RHIhub Substance Use Disorder Toolkit. https://www.ruralhealthinfo.org/toolkits/substance-abuse/2/harm-reduction/syringe-servicesLinks to an external site.

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A Nurse’s guide (6th ed.). Jones & Bartlett Learning.