Benchmark – Policy Brief

The benchmark assesses the following competencies:

1.4 Participate in health care policy development to influence nursing practice and health care.

Research public health issues on the “Climate Change” or “Topics and Issues” pages of the American Public Health Association (APHA) website. Investigate a public health issue related to an environmental issue within the U.S. health care delivery system and examine its effect on a specific population.

Write a 750-1,000-word policy brief that summarizes the issue, explains the effect on the population, and proposes a solution to the issue.

Follow this outline when writing the policy brief:

1. Describe the policy health issue. Include the following information: (a) what population is affected, (b) at what level does it occur (local, state, or national), and (c) evidence about the issues supported by resources.
2. Create a problem statement.
3. Provide suggestions for addressing the health issue caused by the current policy. Describe what steps are required to initiate policy change. Include necessary stakeholders (government officials, administrator) and budget or funding considerations, if applicable.
4. Discuss the impact on the health care delivery system.

Include three peer-reviewed sources and two other sources to support the policy brief.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

1 postsRe: Topic 4 DQ 1

The health care system consists of clinicians, insurance companies or it’s plans, employer groups, health care facilities; such as a hospital, a network of organizations that are combined to facilitate the care to the individual or population with health care. The health care system, when it comes to insurances is challenging for me to understand. I was a case manager and would submit plan of cares for patient’s authorizations and there were always challenging and upsetting moments. The way the U.S has the health care system set up can be confusing.

 The deliverance of the health care is either via private – owned groups, healthcare networks, HMO’s and PPO’s. The types of facilities that provide health care are private practices, hospitals, US Government health facilities, academic medical centers, psychiatric hospitals, nursing homes, long term facilities, rehab facilities, and any other approved medical facility.

 The United States has the highest costs for health care than any other country. “Health care costs were about $3.3 trillion dollars in 2016. For decades, the amount of money spent on health care has increased more than the overall economy has grown (Roger I. Schreck, 2018)”. The health care debt increases due to nonfunded population. If people cannot afford healthcare insurance, most likely won’t be able to pay for their health care costs. The Affordable Care Act in 2014, helped minimize the amount of population uninsured. The financing aspect is either through private voluntary or public programs.

 The U.S Department of Health and Human Services is the primary agency that manages the U.S health care system. The list of the organizations that fall within the HHS agency are: Centers for Medicare and Medicaid Services, Centers for Disease Control and Prevention, National Institutes of Health, Health Resources and Services Administration, Agency for Healthcare Research and Quality, Food and Drug Administration, Center for Medicare and Medicaid Innovation, Patient Centered Outcomes Research Institute, National Academy of Medicine, and Joint Commission.

The sustainability methods include system integration and care coordination. “In 2011, the U.S. Department of Health and Human Services released the National Quality Strategy, a component of the ACA that lays out national aims and priorities to guide local, state, and national quality improvement efforts, supported by an array of partnerships with public and private stakeholders (The Commonwealth Fund, 2019)”.

Quality patient care and their health outcome is how many (if not all) facilities are reimbursed by CMS. I believe the outcome would be greater if health care focused on preventative and accessible care. Cost of health care services needs to be regulated. The type of response of being proactive rather than reactive is the best step. I do not fully understand the health care system, and I took courses for clinical case management. The courses consisted of heath care insurances and the many topics that were asked in this discussion. If I do not fully understand with that background, it might be challenging as well for someone who does not have the same background. I do hope reforming the health care system will mean a greater outcome.

 

This week you reflected upon the difference between a “manager” and a “leader” and discussed this concept with your classmates and professor in the discussion board. In a written essay please answer the following questions:

• What are the differences between leaders and managers? What characteristics are similar and what are different?
• Provide a total of three examples. First, of someone who has great managerial skills. Second, another individual with great leadership skills. Third, another person with poor managerial skills. These can be made up individuals or examples you have seen without any identifying information. Discuss how the staff of each individual would be affected by the skills of the leader/manager.

Agencies for Quality.

• 1. The Institute of Medicine,
• 2. The Agency for Healthcare Research and Quality,
• 3. The National Quality Forum,
• 4. The Joint Commission,
• 5. The Magnet Recognition Program,
• 6. The Institute for Healthcare Improvement,
• and, of course, the nursing student’s friend, Quality and Safety Education for Nurses (QSEN).

 Explore one of the agencies for quality improvement listed in this module’s lecture. Write a one-page summary of what the agency does, who it affects, and how it is utilized. 

Respond  on 2 different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.

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Knee Pain SOAP Note  

Patient Information:SJ, 15-year-old WM

S.

CC– Pain in both knees.

HPI: 15-year-old white male presents with pain in bilateral knees.  Pain onset was 1 week ago after football practice.  Pain is described as “dull”.  Associated s/s include clicking in one or both knees and a catching sensation under the patella. SJ describes pain as dull and constant, pain rated at 3 on a scale of 0-10. Pain is exacerbated by movement and relieved by rest.  

Current Medications: No medications, no OTC medications or vitamins.

Allergies: seasonal allergies only

PMHx: Immunizations current, flu shot received from PCP 10/5/19.  No previous injuries, hospitalizations, or surgeries.

Soc Hx: 10th grade student, on high school football team (offensive lineman), has played football since age 6.  Denies alcohol use, denies tobacco use, Denies use of illicit drugs.  Honor student, popular in school with many friends. Lives at home with dad and two younger sisters.  Mom is active duty/deployed currently.  Currently learning to drive in driver’s education at school.

Fam Hx: No significant medical history in parents. Maternal grandmother died at 80 of lung cancer, grandfather at 81 of MI.  Paternal grandmother has osteoarthritis, grandfather has DM.  

ROS: GENERAL:  Denies weight loss, fever, chills, weakness or fatigue.

HEENT:  Head: denies headache, 

Eyes: Denies visual loss, blurred vision, or double vision, denies hearing loss, nasal dysfunction or sore throat.

SKIN:  denies rash or puritis.

CARDIOVASCULAR:  Denies chest pain, chest pressure or chest discomfort. Denies palpitations or edema.

RESPIRATORY:  Denies shortness of breath, cough or sputum.

NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. Denies change in bowel or bladder control.

MUSCULOSKELETAL:  Knee pain, with clicking and catching sensation under the patella. Denies back pain, stiffness.

HEMATOLOGIC:  Denies anemia, bleeding or bruising.PSYCHIATRIC:  Denies depression or anxiety.

ALLERGIES:  Denies food or drug allergies, allergy to pollen.

O.

VS: BP 123/68; P 89; RR 18; T 97.6; O2 98%; Wt 179; BMI 25.68

General– AOx4. Pt appears healthy and well nourished, athletic build.  Well groomed, no acute distress noted.

Cardiovascular- Regular rate/rhythm. S1/S2 heard, no murmurs, gallops, or rubs noted.   

Respiratory– RR even and unlabored. Clear to auscultation bilaterally with no wheezing, rales, rhonchi, or crackles.

Musculoskeletal- joint stability normal in upper extremities, no tenderness to palpation.  Lower bilateral popliteal tenderness upon palpation, Rt quadricep angle 18 degrees, Lt quadricep angle 20 degrees.  Bilateral inflammation present in the distal extensors.

Diagnostic results: CBC: WBC-5.9 Hgb- 16.1  Hct- 49 Platelet count- 210, X-ray McMurry test negative, Lachman test negative, MRI- negative for meniscus tear, negative for ACL tear, negative for CP.

A.Patellar tendinitis- This overuse syndrome is characterized by inflammation in the distal extensors of the knee joint (Dains, Baumann, & Scheibel, 2019). Patellar tendinitis is more common in athletes who habitually place excessive strain on their knees from jumping or running (Dains, Baumann, & Scheibel, 2019). Determine the quadriceps angle by measuring the angle between the center of the patella to the anterior superior iliac spine and from the center patella to the tibial tubercle (Dains, Baumann, & Scheibel, 2019). An angle greater than 10 degrees in males and 15 degrees in females suggests patellar tendinitis (Dains, Baumann, & Scheibel, 2019). People affected complain of dull, achy knee pain that may have associated clicking or popping (Dains, Baumann, & Scheibel, 2019).

Medial meniscus tear- clinically examined with McMurray’s test and joint line tenderness for clinical diagnosis of medial meniscus tear (Gupta, Mahara & Lamichhane, 2016). The presence of pain and/or click/snap/clunk/thud was considered positive for the McMurray’s test. Joint line tenderness was tested in 90 degree of knee flexion (Gupta, Mahara & Lamichhane, 2016).Anterior cruciate ligament tear- Patients with ACL tears typically present with acute injury, sometimes with an associated “pop,” a sensation of tearing, the immediate onset of effusion, or any combination thereof.  Better tests are the Lachman test and the pivot-shift test, which have reported respective sensitivities of 0.87 and 0.49 and specificities of 0.97 and 0.98 (Volker & Karlsson, 2019). The pivot-shift test is a dynamic test of the rotatory laxity of the knee that produces subluxation and reduction (felt as a “clunk”) of the lateral tibial plateau (Volker & Karlsson, 2019). Although plain radiography is often the first diagnostic step after the physical examination to rule out fracture, dislocation, or both, magnetic resonance imaging (MRI) is strongly recommended as part of the diagnostic evaluation, given its reported high sensitivity and specificity (97% and 100%, respectively) for the detection of ACL injury (Volker & Karlsson, 2019).

Acute leukemia- Leukemia is the most common cancer in children, and bone and joint pain is the most common presenting complaint (Dains, Baumann, & Scheibel, 2019). The bone pain is diffuse and nonspecific and may extend to adjacent joints (Dains, Baumann, & Scheibel, 2019). Laboratory findings may show the WBC count as elevated, depressed, or normal; severe anemia is common, as is a depressed platelet count (Dains, Baumann, & Scheibel, 2019). Radiographs of the limb at the distal end of the femur and the proximal end of the tibia show abnormal areas of radiolucency (Dains, Baumann, & Scheibel, 2019). 

Chondromalacia Patellae- Chondromalacia patellae (CP) represents a spectrum of abnormalities, including softening, swelling, fraying and erosion of the hyaline cartilage overlying the patellae and sclerosis of underlying bone (Harman et al., 2003). Patients with CP experience pain as the articular cartilage begins to degenerate and abnormal stresses are transferred from the elastic, shock-absorbing cartilage to the subchondral bone (Harman et al., 2003).  MRI, with its multiplanar capabilities, excellent soft tissue resolution and noninvasive nature, has been studied in the evaluation and staging of chondral lesion in the knee (Harman et al., 2003)

P. This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

                                              References

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care(6th ed.). St. Louis, MO: Elsevier Mosby. Gupta, Y., Mahara, D., & Lamichhane, A. (2016). McMurray’s Test and Joint Line Tenderness for Medial Meniscus Tear: Are They Accurate? Ethiopian Journal of Health Sciences, 26(6), 567–572. https://doi-org.ezp.waldenulibrary.org/10.4314/ejhs.v26i6.10Harman, M., Ipeksoy, U., Dogan, A., Arslan, H., & Etlik, O. (2003). MR arthrography in chondromalacia patellae diagnosis on a low-field open magnet system.Clinical Imaging, 27(3), 194-9. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1016/S0899-7071(02)00521-1 Volker, M., & Karlsson, J. (2019). Anterior cruciate ligament tear. The New England Journal of Medicine, 380(24), 2341-2348. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1056/NEJMcp1805931