DNP 825 Topic 5 Discussions 1 GCU Nov 2021

DNP 825 Topic 5 Discussions 1 GCU Nov 2021   DNP 825 Topic 5 Discussions 1 GCU Nov 2021 Topic 5 DQ 1 In creating a new community-based health program, what program development model would you use and why? What recommendations would you suggest to make the program successful and sustainable? Provide examples and relevant literature to support your response. When creating a new community-based health program, it is important to start by assessing the needs and resources of the community, and developing a plan about how to identify local needs and resources, and finally identifying the assets and resources of the community. You then need to plan by developing a framework or model of change, creating strategic and action plans, and then overviewing the vision, mission, objectives, strategies, and action plans (VMOSA). Planning provides overall direction on the road that leads from where things are now to where we hope they will be. It can be helpful for a group to develop a clear vision, a mission statement, objectives, strategies, and an action plan (Community Tool Box, 2020). Once you have identified something you are passionate about and your community care about, acting is the next step. You need to develop an intervention, mobilize people by increasing participation and membership, and conducting a direct-action campaign to carry your intervention. You will then evaluate to see if your initiative is working and if it needs adjustments. Sustaining the initiative is particularly important to making sure your labor is not in vain. You need to develop strategies to sustain your initiative and plan for long-term institutionalization. A program development model that I would use will be the Population-Based Models. The models are applied to various diseases and can be sustain over a period from good health to end of life care. It is a continuum process and patients can move from one area of health into another. These models are designed to offer both telephone and field care in prevention, disease management (DM), care management, case management and care integration. Outreach to patients may depend on their acuity levels, and the frequency of contacts may depend on the clinical assessments and care planning of the patients. DM programs often have a care coordination component, which can provide such things as assistance in placing patients in a medical home, medical transportation (to help reduce the overuse of emergency medical services and ED care), or help in finding funding sources for medication management (to avoid disease exacerbations due to medications not being filled), and so on (Cupp Curley, 2020). A good example of a DM program will be the Depression Care Management (DCM) program that was implemented within our organization about a year ago. This program was developed due to the loss of service within our mental health department. An assessment was conducted determining that patients were lost to service and not taking their medication and having higher hospitalization rates for suicidal attempts. We had to implement a program to keep patient engaged in service. Each patient ordered an antidepressant was contacted by a mental health Registered Nurse (RN) to for care management for a period of 6-8 months until stable on the medication. This was also to see if there were improvement in our SAIL (Strategy Analytics for Improvement and Learning) measures. We as mental health RNs were responsible for making sure we impact some of the measures by improving our depression screening (PHQ-9) and medication adherence within our population. If no improvement is notice in the patient’s outcome after 6 weeks of initiating antidepressant therapy, then a change in treatment or dose increase is require by the prescriber. It also requires collaboration between the RNs, Pharmacists, Doctors, Nurse Practitioners, and Physician Assistants. The program is a nurse-led program that is focus on prevention and treatment of depression. The program focuses on multiple strategies to create change in patients’ behavior regarding antidepressant. Nurses need to be able to develop skills and strategies that lead to desirable outcomes for patients. Motivational interviewing and health education are primary strategies to engage patients into modifying their behaviors, but a hallmark of all these programs is ultimately a change in health behaviors, which leads to desired outcomes (Cupp Curley, 2020). Community Tool Box. (2020). A model for getting started. Retrieved from Cupp Curley, A. L. (Ed.). (2020). Population-based nursing: Concepts and competencies for advanced practice (3rd ed.). New York, NY: Springer Publishing Company. ISBN-13: 6749 Dr. Hendrickson and class, What I find confusing after reading this week materials on uninsured population in the United States (US), is why congress continue to fight this issue and make it about partisan when there have been facts that the entire population suffer the cost. The facts have been laid out by the Institute of Medicine and other reputable public health institutes about the impact of being uninsured. The IOM concluded that health insurance is integral to personal well-being and health. The IOM committee report for 2004 states “…health insurance contributes essentially to obtaining the kind and quality of health care that can express the equality and dignity of every person. Unless we can ensure coverage for all, we fail as a nation to deliver the great promise of our health care system, as well as of the values we live by as a society. It is time for our nation to extend coverage to everyone” (2009). I find it difficult that Americans still argue that health insurance is not right for all. The cost of insurance will continue to rise especially now with the pandemic and with so many people becoming unemployed. Most Americans will not be able to afford insurance due to the rise in cost. Cost still poses a major barrier to coverage for the uninsured. In 2014, 48% of uninsured adults said that the main reason they lacked coverage was because it was too expensive (Kaiser Family Foundation, 2015). Institute of Medicine. (2009). America’s uninsured crisis: Consequences for health and health care. Retrieved from Kaiser Family Foundation. (2015). Key facts about the uninsured population. Retrieved from Hi Hope, You made some great points in your post about the Precede-Proceed model. The model is a great for behavior changes within the population. Explaining health-related behaviors and environments and designing and evaluating the interventions needed to influence both behaviors and the living conditions that influence them and their consequences are the goals of the model. This model could work great for public health issues like we are currently experiencing relating to COVID-19. Due to the its health promotion and disease prevention framework, and interventions such as practicing safety guidelines (masks, social distancing, and hand hygiene measures). The PRECEDE-PROCEED model provides a structure that supports the planning and implementation of health promotion or disease prevention programs. This model has worked well for many health promotion topics and can effectively support one-time interventions or long-running programs (Rural Health Information Hub, 2020). Rural Health Information Hub. (2020). Precede-proceed. Retrieved from Attempt Start Date: 13-Aug-2020 at 12:00:00 AM Due Date: 15-Aug-2020 at 11:59:59 PM Maximum Points: 5.0 Topic 5 DQ 2 In reviewing the Affordable Care Act, what are potential effects of having the option for insurance coverage in both the private and public sectors? How will this impact the discussion about population-based nursing? Provide examples and relevant literature to support your response. In reviewing the Affordable Care Act (ACA), uninsured people were able become insured and had accessible healthcare. Statistics show that ACA decreased the probability of being uninsured by 20.9 to 25 percent. Gaining insurance coverage also increased the probability of having a usual place of care by between 47.1 percent and 86.5 percent. These findings suggest that not only has the ACA decreased the number of uninsured Americans but has substantially improved access to care for those who gained coverage (Glied, Ma, & Borja, 2017). ACA was able to meet one of its major goals of health reform: expanding insurance coverage and increasing access to care by decreasing uninsured Americans from 41 million to 27 million. Although many Americans in underserved populations were able to become insured, it was also difficult for the working-class Americans who had to deal with the increase of the marketplace. Working class Americans experience increase in cost of premiums, making it difficult to decide on the quality of care vs the cost. Selecting a plan with lower premiums meant less quality services. Middle-class and older adults are especially vulnerable to high insurance costs for ACA coverage because of two features of the law. One is a “cliff” in which premium subsidies end at 400 percent of the federal poverty line, nearly $49,000 for an individual and just over $100,000 for a family of four (Goldstein, 2019). Having insurance and access to care will greatly impact discussion for population-based nursing because more education about preventive care need to echo to the population who are at risk. Individuals need to understand their risk factors and get educated about how to prevent chronic diseases and manage healthcare cost as a society. Nurses are in the best position due to their direct relationships with patients and their families. Nurses need to implement more population health models to meet the health needs of the population. The population health model “seeks to eliminate healthcare disparities, increase safety, and promote effective, equitable, ethical and accessible care” (Cupp Curley, 2020). Improving the quality of care and decreasing the cost of care will take nurses driving the force on prevention, screening, and patient self-care management. For example: if nurses can implement programs to prevent diabetes, they can help lower the rates of diabetic patients who progress to End Stage Renal Disease (ESRD), therefore increasing the healthcare cost with dialysis and other treatment for ESRD. Preventing diabetes will save cost in the long-term. Cupp Curley, A. L. (Ed.). (2020). Population-based nursing: Concepts and competencies for advanced practice (3rd ed.). New York, NY: Springer Publishing Company. ISBN-13: 6749 Glied, S. A, Ma, S., & Borja, A. (2017). Effect of the Affordable Care Act on health care access. Retrieved from Goldstein, A. (2019). ACA premiums rising beyond reach of older, middle-class consumers. Retrieved from Attempt Start Date: 13-Aug-2020 at 12:00:00 AM Due Date: 17-Aug-2020 at 11:59:59 PM Maximum Points: 5.0 Case Report: Application of Public Health Concepts for the Uninsured In this assignment, learners are required to write a case report addressing the personal knowledge and skills gained in this course and potentially solving an identified practice problem. General Guidelines: Use the following information to ensure successful completion of the assignment: • This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. • Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center. • This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included. • You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. Directions: Review "Key Facts About the Uninsured Population" and "America’s Uninsured Crisis: Consequences for Health and Health Care" to develop a case report that identifies a clinical or health care problem and proposes methods of intervention, implementation, and evaluation using an appropriate research instrument. Construct a 2,500-3,000 word (approximately 10-12 pages) case report that includes a problem or situation consistent with a area of DNP practice. Your case report should include the following components: 1. Introduction with a problem statement 2. Brief literature review 3. Description of the case, situation, and conditions as explained from a theoretical perspective 4. Synthesis of literature findings 5. Summary of the case 6. Identification of gaps or inefficiencies in the research and a proposal for evidence-based solutions to remedy each 7. Evaluation of the selected research instrument used and an explanation of the rationale or empirical evidence to support its selection 8. Explanation of how this case report advocates for social justice, equity, and ethical health care policies for uninsured populations. 9. Conclusion Portfolio Practice Immersion Hours: Practice immersion assignments are based on your current course objectives and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours and are indicated in the assignment by a Portfolio Practice Immersion Hours statement that reminds you, the learner, to enter a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10. You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network. To earn portfolio practice immersion hours, enter the following after the references section of your paper: Practice Immersion Hours Completion Statement DNP-825 I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice immersion hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor. RUBRIC Attempt Start Date: 13-Aug-2020 at 12:00:00 AM Due Date: 19-Aug-2020 at 11:59:59 PM Maximum Points: 100.0