hi dear,

can help me to finish this assignment with good quality and be on time please?

Please follow the instructor carefully.  You are expected to post a primary response to the discussion topic. All posts should address the discussion topic/question, add to the discussion, and/or encourage others to respond. Facts and claims MUST be supported with APA format citations and references. Use personal experience, course resources such as textbook and additional readings, library references and resources, and well-reputed internet sources, which includes reputable media sources, as well as scholarly sources. Your primary response to the topic/questions posed should be 2 -3 paragraphs, and be thoughtful, well-written, and include appropriate APA in-text citation(s) and reference(s) when appropriate.

This week discussion is centered on drafting a letter to your local representative regarding a position on a piece of legislation. 

Communicating with elected officials is an important part of public health advocacy.  Written communication to the different branches of government is often used by health and advocacy groups to ensure their perspective is considered in the debate on an issue. 

Advocacy groups often engage their member advocates in campaigns to directly communicate to their representatives to assure the community voice is included in the discussions and to influence legislators and regulators.  Constituents’ (you, the residents and voters) input on issues is a valued part of the democratic process and should not be underestimated.  Elected officials often make decisions about voting, and even introducing bills in response to public communication. You are writing a draft letter for your primary post.

· Visit this site or this site to find different representatives you may be interested in writing an advocacy letter to. Enter your address to find your representatives at the Federal, state and local level. Identify which level of government you wish to send a letter to and find that elected official’s address.

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· For the letter:

· Begin your letter and include the representatives name and legislative title you are writing the letter to:

The Honorable John Doe,

US Congress, 53rd District

123 Elm St

San Diego CA 92103

· Include the constituents (your) local address, email address or web form url in the address line (this information can be created and does not have to be your actual information).

· Have an introduction and an advocacy issue appeal (should be at least three paragraphs total).

· The introduction includes information about your personal experience, education, and interests and must include a statement of your constituency. It also introduces the issue you want to have addressed in one sentence or less.The advocacy appeal is a statement on behalf of a community asking for the issue to be addressed, thanking them for a recent vote on the issue, or expressing disappointment or concern about their vote or an issue .  It often includes education about the issue, and is backed up by fact. For this assignment, your appeal should include a policy option. Advocacy for a general solution about the problem includes suggesting a policy option or principle you think will address the problem.

· Constituency means all the people (voters), served by a particular elected official, especially a legislator. In other words, a district that is representative of a specific legislator. For example, I live in Carlsbad, which is the 49th congressional district in California. It is represented by Congressman Darrell Issa

· Do NOT lobby (your letter may not ask for a specific bill, or a specific way to vote)

· Please review the advocacy sample letter in your text. This is a perfect example of a way to advocate for a cause without leaning towards lobbying. The example is in Chapter 17, p.335. Read the paragraph prior to the example letter that begins with: “There are many ways to advocate on behalf of a public health issue….”.

For more details about writing letters to elected officials, see the Community Toolbox: http://ctb.ku.edu/en/table-of-contents/advocacy/direct-action/letters-to-elected-officials/main

Other sample letters:

APHA: these are a bit lengthy, but helps you understand the gist of letters to congress, etc…

American Lung Association: sample letters

Each student will also respond to two peer posts.  Each peer post is expected to give constructive feedback to your peers,  to identify ways that this letter could be improved or enhanced.  Use course concepts. 

Sources: 

· You are required to use at least TWO sources from the textbook, government reports, peer-reviewed journal articles or textbooks. Use your OWN WORDS (e.g., do not cut and paste from a government report or article). 

·  Paraphrase (use your own words) to report the information.

· Include APA formatted in-text citations to identify your sources AND include full APA formatted references for your sources at the end of your post.

o Purdue OWL APA Guide

Thanks,

4 postsRe: Topic 3 DQ 1

A vulnerable population is a group of people who need special considerations in regard to their health and overall welfare (Falkner, 2018).Vulnerable populations are individuals who are not able to advocate for themselves due to physical, cognitive or mental disability, emotionally unstable people, children and incarcerated individuals.These populations usually have several social determinants of health(SDOH) that contribute to their vulnerability.These SDOH can include poverty, socioeconomic status, race and ethnicity, sexual orientation and no insurance or the underinsured.

 In the United States there are many vulnerable populations.One group that gets a significant amount of media coverage is the lesbian/gay/bisexual/transgender/questioning (LGBTQ) population.The inequality and hardship this group often encounters within the medical community and the higher instance of medical conditions such as Hepatitis B, HIV and AIDS is what makes this population considered vulnerable (Falkner, 2018).In the US, it is estimated that 10 million adults identify as LGBTQ (American Nurses Association [ANA], 2018).Many individuals within the population have reported prejudice from medical providers, leading to reluctance to seek care or delay in treatment due to the bias experienced.The stigma in society, discrimination and failure to recognize the unique civil and human rights deters individual self-determination and access to care which causes negative health outcomes and overall increase in morbidity and mortality (ANA, 2018).All nurses, not just CHN need to understand their own preconceptions and bias when caring for this vulnerable population.Ethically, nurses have a responsibility to provide safe, competent care to all individuals regardless of age, sex, sexual preference, race, ethnicity or socioeconomic status.

Within my facility, they have an actual process to review or revise policies that staff could do if they feel that something is out of date, or just needs a review. In the request to change a policy or procedure, it states, “If there is a REVISION to the document, are the revisions such that staff education/awareness is needed? How will this be accomplished? Who is responsible?” (Bellin Health, 2019) This shows that it is more than just an organizational thing. When something gets changed, more than us need to know about it. For example, if we change a policy for what company we use to transport patients, more than us have to know, and approve, this change. It impacts more than just our organization. Changes need to be supported by more than just the group that is changing it because it impacts the community. Going back to my example, if we change who we use for transportation, it impacts the drivers, the patients, their families, the hospital staff, and countless other people. Most everyone, if not all, should be supportive. Without support, it is hard to change anything. Support really helps ‘snowball’ things and get things rolling in the right direction. I already have the support of my mentor, and I feel that my department will have my support because it is something that we have to work on, and the policy that we are using now may not be the best for our department. I will put my research in our department’s weekly huddle and see what their thoughts on how to fix the problem. They may have some good ideas that I have not thought of and research from there. REFERENCEBellin Health. (2019). Process for the review/revision of policies & procedures. Unpublished internal 

Integrating Evidence-Based Practice

Write a 1000-1500 word essay addressing each of the following points/questions. Be sure to completely answer all the questions for each bullet point. There should be two main sections, one for each bullet below. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with (2) sources (1 outside source and the textbook) using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount. Review the rubric criteria for this assignment.

Part 1:

Describe the eight steps to integrating evidence-based practice into the clinical environment. What barriers might you face in implementing a new practice to address your research topic (as identified in Module 1)? Describe strategies that could be used to increase success including overcoming barriers. 

Part 2: 

Describe six sources of internal evidence that could be used in providing data to demonstrate improvement in outcomes.

Assignment Expectations:

Length: 1000 – 1500 words
Structure: Include a title page and reference page in APA format. These do not count towards the minimum word count for this assignment. Your essay must include an introduction and a conclusion.
References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of one (1) scholarly source and the textbook are required for this assignment.

Below is what was discussed in Module 1 

Clinical Question

 In terminally ill patients and their families (P), how does the provision of educational programs to demystify benefits of hospice care (I) as compared to informal community education (C) influence their ability to increased awareness of the best options and benefits of hospice care (O) within a period of hospital stay (T)? 

Justification for the Clinical Problem

 This paper describes a hospice educational program for terminally ill patients. The main focus of this study is the lack of accurate and inconsistent information on the benefits and options of hospice care. There is a large gap of eligibility, philosophies and knowledge concerning hospice care for patients facing end of life transition. Most studies that have been carried out on the topic have either been biased or provided less detailed information on the importance of creating awareness of the benefits of hospice care for terminally ill patients. Lack of knowledge about the importance of hospice care has led to increased number of people living their last days without receiving the benefits of this service (Garcia, 2018). 

 Most families learn about the benefits of hospice care care when it is too late for the patient. In addition, the families learn about the advantages of the service once the patient has already been admitted in the program. The main reason for enrolling their terminally ill patients to the program is not because they know its benefits but for the lack of another option. The significance of this study is to help patients and families to enroll in hospice care early enough in the course of a life limiting illness for them to receive comfort care and experience easier transition. 

 According to Tofthagen, Guastella, & Latchman, 2019), the need for palliative and hospice care program has increased as people are living with complex diseases with no cure and population ages. The study suggests more hospice care professionals will be needed in the near future to meet the increasing demand for the services (Tofthagen, Guastella, & Latchman, 2019). Lack of knowledge on the importance of these services has resulted in families keeping terminally ill patients at their homes. The authors of this study suggest that providing educational programs to communities could help reduce the number of terminally ill patients who are not receiving these services (Tofthagen, Guastella, & Latchman, 2019). 

 Another study conducted in 2020, found out that healthcare professionals in the hospice care setting can only provide effective services to patients if there is a conceptual framework to guide practice and education (Dyess et al., 2020). The study suggests that most people are unable to access hospice care because of lack of knowledge. “The framework builds on theoretical caring to convey elements of relational, holistic and compassion; articulates inter-professional tenets for guiding values; and aligns with constructs for palliative and hospice best practices” (Dyess et al., 2020). The study suggests that such a framework invites leaders as well as clinicians to develop educational programs to promote awareness about hospice services. 

 According to Allo et al., (2016), healthcare professionals do not have exposure to provide quality home based care. This is as a result of lack of enough education among healthcare practitioners to attend to home-based patients. The study suggests that participation in patient home visits is an effective way to provide education in communities about the benefits of hospice care (Allo et al., 2016). This approach does not cause any form of distress to both patients and their families. As a matter of fact, families who participated in this study were quick to enroll their patients to hospice care (Allo et al., 2016).

 In another study conducted in 2019, the authors argue that most terminally ill patients do not have access to hospice services due to lack of knowledge in the communities (Livingstone, Welstand & Ryan, 2019). However, such patients would enroll to hospice care services if they were aware of its benefits. Livingstone, Welstand & Ryan, (2019), found out that the fears associated with end of life include not being able to stay at home, burden to the family and also fear of undignified death. Most terminally ill patients would therefore enroll to such programs to reduce these fears if they had enough knowledge. 

Article that Best Supports the Topic

 In a study conducted in 2018, the authors argue that hospice care is a service that has been widely misunderstood and underutilized (Garcia, 2018). Communities are not aware of hospice services. This results in increased suffering for patients having life limiting illnesses. Misconceptions by communities also lead to the lack of enrolling terminally ill patients to the service. Most people believe that the service is only provided for six months. People also don’t understand their illnesses as well as the treatment goals for hospice care. While there are many hospice care organization in communities, lack of clarity on who should handle this conversation exacerbates the situation (Garcia, 2018). 

 Limited knowledge, misconceptions and poor communication among patients and within the health care profession, have led to terminally ill patients not being referred on a timely manner (Garcia, 2018). Communities do not have enough knowledge to identify the identify patients who need hospice care. Late referrals have led to patients being denied access to hospice care at the end of their life. The underutilization of these services has resulted in poor communication and ineffective identification of those patients who deserve end of life care. The underutilization of hospice care leads to poor quality of life for terminally ill patients and also increased healthcare services (Garcia, 2018). 

  This article provides ways in which terminally ill patients and their families can access education programs to help them understand the benefits of hospice care services. The article also provides insights on the importance of providing educational programs to communities (Garcia, 2018). The other article focus more on the importance of providing hospice care rather than the importance of educational programs on hospice care services. Unlike the other selected articles, this article provides recommendation educational programs on the importance of hospice care can be administered in the community. By implementing this recommendation most people suffering from life limiting illnesses can access hospice car and end their life with dignity. 

References

Allo, J. A., Cuello, D., Zhang, Y., Reddy, S. K., Azhar, A., & Bruera, E. (2016). Patient Home Visits: Measuring Outcomes of a Community Model for Palliative Care Education. Journal of palliative medicine, 19(3), 271-278. Retrieved from https://www.liebertpub.com/doi/abs/10.1089/jpm.2015.0275

Dyess, S. M., Prestia, A. S., Levene, R., & Gonzalez, F. (2020). An Interdisciplinary Framework for Palliative and Hospice Education and Practice. Journal of Holistic Nursing, 0898010119899496. Retrieved from

https://journals.sagepub.com/doi/abs/10.1177/0898010119899496

Garcia, M. J. (2018). Systematic Review of the Literature on Why There is Hospice Underutilization. Retrieved from https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=6288&context=dissertations

Livingstone, T., Welstand, J., & Ryan, K. (2019). P-188 Improving access to hospice enabled care for heart failure patients–a service evaluation. Retrieved from https://spcare.bmj.com/content/9/Suppl_4/A79.3.abstract

Tofthagen, C., Guastella, A., & Latchman, J. (2019). Perspectives on Hospice and Palliative Care in the United States. In Hospice Palliative Home Care and Bereavement Support (pp. 105-119). Springer, Cham. Retrieved fromhttps://link.springer.com/chapter/10.1007/978-3-030-19535-9_7