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1.   In your owns words and using the appropriate evidence-based practice reference please define health promotion and wellness and give some examples.  Mention at least two health issues and how they could be addressed through both professional health promotion and personal health promotion. What is the difference in the approach? How does each approach contribute to the desired effect?

2.  Should health insurance companies cover services that are purely for health promotion purposes? Why or why not? What about employers? What are the pros and cons of this type of coverage?

3.    What do you think about the role of integrating nursing with faith? Do you feel is appropriate? When is it appropriate? In what types of settings do you feel this would work best in? Do you feel all nurses should integrate faith in their nursing practice? Why or why not and how?

4.   In your own words and using the appropriate evidence-based references please define groups and identified and describe at least two groups in your community.  Why do nurses need to know about group dynamics and how to work in a group?

A minimum of 3 evidence-based references no older than 5 years  (excluding the class textbook) is required. You must post at least two replies to any of your peers sustained with the proper references.  A minimum of 600 words is required (excluding first and last page).

****DUE IN 8-10 HOURS!

Assignment 

Go to the link below and read article:

https://www.regulations.gov/document?D=CMS-2018-0053-0002

Now, in a complete 1-2 pages paper address the following questions properly: (I attached the required readings):

1) What agency issued this proposed rule?

2) To be considered, when must comments be received by?

3) List 3 ways of submitting comments about this proposed rule:

4) In what section of a subsequent document will the agency respond to comments received about this proposed rule?

5) Pursuant to Executive Order 12866, what office reviewed this proposed rule?

6) If you were an administrator at a hospital with an inpatient psychiatric unit and wanted to submit comments to this proposed rule, who might you collaborate with to draft your comments so that your comments could be as effective as possible?  List the position title/role of this person and briefly explain why you chose this type of person as a collaborator. 

****Provide 2-3 credible references cited in APA.

1-You made some good points Judy, but the U.S is not the only one struggling with the health care . I was reading different articles and realized there are so many countries going through the same things and maybe even worser. The Pakistan’s health profile portrays high maternal and child mortality, increase population growth rate, and the twofold burden of infectious and non-infectious diseases (WHO, 2007).Just 27% of the Pakistani people avail advantage from full coverage of health care that include armed force members, beneficiaries and government employees, whereas, the rest 73% of the population pay out of pocket (Settle, 2010).They are viewed as a country that is not really important and get overlooked and struggle with health care. People are still paying a crazy amount of money just to get the care they need to stay healthy. With everything going on it makes it hard and for people to reach out when they really need it and it progresses to where it can not be reversed and as a nurse it just sucks seeing people go through this and hope it gets better as the years pass. 

2-Many American families have a limited access to health and are uninsured. Our healthcare system focuses more on treatment and medical services than preventive care. Health care spending has been increasing over the years, yet there isn’t a significant improvement in health outcomes (Kaiser Family Foundation, 2017). In 2013, $2.9 trillion dollars was spent on the healthcare alone, which is about $9,255 per person (Levitt, Claxton, Cox, Gonzales & Kamal, 2014). For insured families, insurance premiums have risen about 11% and household earnings only 3% increase from 1996-2003. Soon, family premiums will cost more than the family income by 2025 if trends continue. All that money spent, yet there coverage in limited/inadequate. Over recent years, insurance premium cost increases have slowed, but this places more of the financial burden on the family (Devoe, 2008).

In 2016, 27.6 million people are not insured. Many low income families cannot afford to pay for health insurance, so they gamble and delay any medical services in fear of how much it will cost them (Kaiser Family Foundation, 2017). Many fear that it could lead to financial ruin. Among families with health insurance, almost half of all personal bankruptcies were due to high medical costs (Devoe, 2008).

There is also the issue of people uninsured when they’re in between jobs or waiting for approval of Medicare/Medicaid. About 82 million Americans have these coverage gaps during a 2-year period (Devoe, 2008). Life is unpredictable, and something can during these gap periods.

References

Devoe, J. (2008). The Unsustainable US Health Care System: A Blueprint for Change. The Annals of Family Medicine, 6(3), 263-266. doi:10.1370/afm.837

Levitt, L., Claxton, G., Cox, C., Gonzales, S., & Kamal, R. (2014). Assessing the performance of the U.S. health system. Retrieved May 24, 2018, from https://www.healthsystemtracker.org/brief/assessing-the-cost-and-performance-of-the-u-s-health-system/#item-start

Kaiser Family Foundation. (2017, December 07). Key Facts about the Uninsured Population. Retrieved May 23, 2018, from https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/

3-I have found that the health care system in the United States is expensive and not easily obtained. There is much room for improvement. The concern about quality arises more from fear and anecdote than from facts; there is little systematic evidence about quality of care in the United States. We have no mandatory national system and few local systems to track the quality of care delivered to the American people. More information is available on the quality of airlines, restaurants, cars, and VCRs than on the quality of health care (Scuster, 2005).  The U.S. does not have a uniform health system, has no universal health care coverage, and only recently enacted legislation mandating health care coverage for almost everyone. This can be difficult for someone who is working minimum wage and has a job that does not require to give employees benefits such as health care insurance. One could argue that minimum wage is not meant to be a long term job for an adult. Though the theory of minimum wage jobs might have originally been meant for minors, the reality of our nation is that many adults living in poverty are employed at minimum wage paying jobs. It should be our duty to provide affordable health care for all members of our nation regardless of our own personal beliefs. Obama Care may not be a perfect system because even though it is said to be afforable health care, it has shown to still not be as affordable as one might need based on their income. However, I believe that this was a good start and can be improved to fit our nation and every individual in it as needed. Health care is only getting more and more expensive with the new medications and technology that we are developing as time goes by. Our nation leaders need to think of someway to have health care available for everyone. One option could be to provide health care for everyone like Canada has for their citizens. Though this comes with problems of its own, I believe that it is a system that cares for all and would great individuals that cannot afford health care. Whatever the United States decides to do regarding the issue of so many Americans being uninsured, something needs to be done quick. With so many people being uninsured, many diseases go untreated or even diagnosed due to the financial fear individuals that are uninsured face. People would rather not see a doctor or a clinic because of the fear that they will bring financial burden to their family. As a nurse, this breaks my heart. 

Schuster, M. A., McGlynn, E. A., & Brook, R. H. (2005). How Good Is the Quality of Health Care in the United States? The Milbank Quarterly, 83(4), 843–895. http://doi.org/10.1111/j.1468-0009.2005.00403.x

1-This is a tough topic.  Here you are, a working family, you are going to school to better yourself even further and you millions of others are still faced with these decisions about health care.  When you say you pray I know you mean that literally because our daughter is in the same boat.  My husband keeps talking about wanting to retire early but he just does not understand the cost of having good health care.  I will probably be working until I am 90 because I will be afraid of Medicare and not being able to afford good care.  Wish we had better answers but we are not getting anywhere fast…that’s for sure. 

2-The most important elements of the Affordable Care Act were to get more people insured, to keep costs down and to improve overall care and outcomes.  New laws were to make affordable health insurance available to more people.  The law would provide consumers with premium tax credits that will lower costs for households that qualify.  To qualify households must have incomes between 100% and 400% of the federal poverty level. Another component was to expand the Medicaid program.  This would now cover all adults with income below 138% of the federal poverty level.  In addition, the goal was to support medical care delivery methods designed to lower costs of health care overall.

As nurses, we need to continue to be innovators and continue our work in research.  We need to focus on continuing to improve on patient safety and improving quality of care.  Nurses need to continue to be lifelong learners and meet demands of a changing society.  We must also continue to raise the bar for education with advanced degrees.  We must continue to push for more diversity in our profession to keep up with our diverse society to make patients more comfortable.  We also need to continue to bring our ideas to the table and be leaders within our organizations.  As we foster interprofessional collaboration the patients will benefit from teams working more closely together to improve patient care. 

3-The key elements of the Affordable Care Act are the following: providing national access to healthcare coverage for the entire population from birth through retirement, this will provide coverage for about 94 percent of the American people, to improve quality, affordability and fairness of health insurance coverage, to enhance healthcare efficiency, quality, diversity and values, to reduce wasteful spending, and to improve public health by expanding clinical preventive care and community investments.

The Act focuses on improving public health by investing in primary health care, especially in medically underserved communities. It also increased insurance coverage for clinical preventive services and procedures. For instance, physical examination, annual wellness visits, well child visits, immunizations, screening exams, like colonoscopy, mammograms and cervical cancer, are all covered by insurance with no cost sharing. In addition, the development of a national preventive plan and the establishment of a Prevention and Public Health Trust Fund, to fund investments in communities that will improve public health. Further investments are being made to in school-based health programs, preventive oral health care, tobacco cessation and adding prevention planning to Medicare.

Nurses are play a vital role and a an extremely important driving force in the implementation of this law. By developing innovative care models like transition of care, home care, care management, and nurse managed clinics, nurses will improve quality of care and lower health care cost.  Also, participating in research to aid in scientific evidence-based practices which improves quality, safety and patient outcome. Advanced practices nurses help increase the availability of primary care providers and provide cost effective care. Lastly, nursing leadership will be needed to implement better workflows to reduce medication errors, improve quality and care coordination, and increasing access to medical care. For these reasons and many others, nurses are of upmost importance in the implementation process of this Act.