• Now that you have  completed Lesson 23 & 24 and have thought about the factors that  affect the health of various communities, do the following:
   

1. Identify prevalent issues or diseases that affect the health of your community (the specific populations you serve).
2. Compare and contrast  two (2) specific populations in your practice that are affected by the  above issue(s) or disease(s) by listing their commonalities and their  differences.
3. Base on the information above, how can you change or refine your practice to meet each community’s specific needs?

• Your paper should: 
• be typed doubled-space.
• a total of 100 to 200 words (not counting your list of commonalities and differences). 
• Use factual information.
• be original work and will be checked for plagiarism.
• have required APA format if references are utilized – type references according to the APA Style Guide.

1- What is Policy?

2- Explain each of them:  Public policy—
Private policy—
Health policy—
Social policy—
Organizational policy?

3- Who was F
lorence Nightingale, and what was her contribution to the Nursing Field? 

4- Who was Lillian Wald?

5- Who was Margaret Sanger, and in what way she helped to the developments of Nursing Field?

6_ what is  (ICN), and what they do?

7- What is  s (NLCA) and they do?

Jeanne Blum, RN, is a nurse on a LDRP unit. Recently, the policy and 
procedures manual for Jeanne’s unit included the premature rupturing of membranes of a laboring patient 
as a practice acceptable for nurses to perform. Jeanne 
and some of her coworkers shared their concern over 
lunch about this new responsibility.They felt uncomfortable with the possibility of cord prolapse and 
other potential medical complications resulting from 
this practice. Jeanne gathered data from her state and 
many others states and noted that her hospital was 
not in compliance with her professional organization
practice standards. Jeanne shared this information with her coworkers. She volunteered to contact the 
state board of nursing on their behalf to request a 
declaratory statement on the nurse’s role in the initiation of premature rupturing of uterine membranes. 
Her state board’s clinical practice committee 
reviewed her request for a declaratory statement and 
gathered information from other states. A formal 
declaratory statement was drafted by the board and 
made it available on its Web site. A letter from the 
board was sent to Jeanne’s institution, informing it of 
the declaratory statement, which stated that the task 
nurses were requested to perform was beyond their 
scope of practice based on the Nurse Practice Act.
8-Which stage of the policy model does this scenario 
represent? 

250 words

3 references APA 

Create a PowerPoint presentation of 14-16 slides with speaking notes on the new regulations impacting the practice as a result of the Affordable Care Act.

Introduction

The Patient Protection and Affordable Care Act (PPACA or ACA) was signed into law by President Barack Obama in 2010. The ACA attempts to increase access to care, reduce cost, and improve quality. Nearly 50 different reform initiatives were implemented between 2010 and 2017. Although primary care is a major focus of the act, these additional initiatives are focused on 10 different areas, including public health, prevention of disease, community health, and increasing revenue provisions to pay for the reform (Niles, 2021). The law has been controversial due to the mandate that all Americans must purchase health insurance.

The U.S. government plays a significant role in the operation of the country’s health care system. Quality, access, funding, education, and preventative services are all influenced by the U.S. government (Niles, 2021), and the Affordable Care Act (ACA) has further increased the role and involvement of the government in health care. All health care administrators must be knowledgeable on the role of the government.

Numerous governmental organizations exist, such as the U.S. Department of Health and Human Services (HHS), the Centers for Disease Control (CDC), the National Institutes of Health (NIH), the Agency for Healthcare Research and Quality (AHRQ), the U.S. Food and Drug Administration (FDA), the Centers for Medicare and Medicaid Services (CMS), the Occupational Safety and Health Administration (OSHA), and the Office of the Surgeon General to name a few. Each organization exists for a specific purpose and has a specific mission. Your role as an administrator will be to understand the scope of these agencies and to help your organization meet or exceed the governmental mandates imposed by each.

Reference

Niles, N. J. (2021). Basics of the U.S. health care system (4th ed.). Jones & Bartlett Learning.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

• Competency 1: Analyze current health reform, policy, and regulation in U.S. health care. 
  • Explain the Affordable Care Act and its impact on the U.S. health care system and on the practice of health care in the United States.
  • Analyze current trends in policy and predict future reforms.
  • Explain how health care reform and policy have impacted health care quality and cost.
  • Explain how regulatory agencies have evolved to address health reform and policy.
• Competency 4: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others. 
  • Produce a presentation that conveys understanding of the topic, its context, and its relevance.
  • Use academic writing conventions such as APA formatting and citation style, or others as required.
  • Produce writing that includes minimal grammar, usage, and mechanical errors, including spelling.

Instructions

Imagine you are an office manager for a ten-physician primary care practice. You have been asked by the physician group to research and give a presentation on the new regulations impacting the practice as a result of the Affordable Care Act. Using the resources provided, plus at least two other peer-reviewed articles based on your own research, develop a PowerPoint presentation of 14–16 slides, complete with speaking notes. Address the following:

• Explain the Affordable Care Act and its impact on the U.S. health care system and on the practice of health care in the United States.
• Analyze current trends in policy, and predict future reforms as a result of the current state.
• Explain how regulatory agencies have evolved to address health reform and policy.
• Explain how health care reform and policy have impacted health care quality and cost.

You might want to (but do not have to) organize your presentation using the following outline:

• Slide 1: Title of the Presentation.
• Slide 2: Brief explanation of the purpose of the presentation.
• Slide 3: The Affordable Care Act.
• Slide 4: Impact on the U.S. Health Care System.
• Slide 5: Impact on the Practice of Health Care in the United States.
• Slides 6–7: Current Trends in Policy.
• Slide 8: Future Reforms.
• Slides 10–12: The Role of Regulatory Agencies (one slide per agency you address).
• Slide 13: Impact to Quality.
• Slide 14: Impact to Cost. 
• Slide 15: Concluding Summary.

Presentation Requirements

Your presentation should consist of:

• 14–16 bulleted slides.
• Speaker notes that fully explain each slide.
• A minimum of two peer-reviewed references, in addition to resources offered in this course or that you find yourself, including government websites.
• Appropriate APA citations and peer-reviewed references on each slide, as necessary.

General Guidelines for PowerPoint

• Keep the design simple. Font: Arial or Verdana, size 24-point, minimum.
• Keep the slides concise: 5–7 bullet points per slide and 5–7 words per bullet. Use speaker notes to explicate the bullets.
• For best color contrast, use light text on dark background (for example, yellow on black, white on dark blue).
• Use the proper slide layout. For example, if a slide has a title and text, it is created using the correct Title and Text layout.

Being anxious about speaking in front of an audience is a natural human tendency.  All people experience some form of anxiety before, during, or after speaking in front of an audience. 

For this discussion board, you will be asked to take a survey on your public speaking anxiety, and then reflect on how you can overcome this anxiety or use it to your advantage.

 For your initial post (due on day 3):

First:

Take the Speaking Anxiety Survey before completing this post (located above the Discussion Board in this module).

Read the following information on speaking anxiety: Speech Anxiety

Next:

Create your post to include the following:

1.  Were you surprised by the score you received on the survey?  (Feel free to share your score if you are comfortable doing so). 

2. Why do you think your score was what it was based on the questions asked?

3.  What has been your experience with public speaking in the past?  Have you had any anxiety about giving speeches or the thought of giving public speeches?

4.  Based on what you have read, what can you do to have less anxiety?

5. Based on what you have read, what should you avoid during a speech to show your audience that you are confident and prepared?

For your Responses:

Make sure to respond to two classmates by day 7.  In your responses make sure to ask questions about your peers’ experiences in an attempt to reflect and start an academic conversation. 

Your score should be between 34 and 170. If your score is below 34 or above 170, you have made a mistake in computing the score.

High = > 131

Low = < 98

Moderate =  98-131

Mean = 114.6;  SD = 17.2

CL.

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

Photo Credit: Getty Images/Ingram Publishing

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

• Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
• Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
• Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
• Think about a personalized plan of care based on these influencing factors and patient history in your case study.

By Day 3 of Week 1

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples
  Pharmacology is the study of the interactions between drugs and the body. The two broad divisions of pharmacokinetics refers to the movement of drugs through the body, whereas pharmacodynamics refers to the body’s biological response to drugs. Pharmacokinetics describes the drug’s exposure by characterizing absorption, distribution, bioavailability, metabolism, and excretion as a function of time, while pharmacodynamics describes drug response in terms of biochemical or molecular interactions (Arcangelo et al., 2017). The focus of this discussion will be in the process of warfarin in term of pharmacokinetics and pharmacodynamics of it in the body.   Ms. J.J. ‘s Health issue:   I was in charge of Ms. J. care couple years ago, a 85 year old African American women who was diagnosed with dementia cerebral infarction due to unspecified occlusion of cerebral artery, arthropathy, major depressive disorder, atrial fibrillation with a history of long-term use of anticoagulants, contracture of muscle, constipation, hypertension and GERD. She is currently on coumadin for the atrial fibrillation and the blood levels are monitoring every week in order to control the drugs therapeutic levels and avoid any adverse reactions.  Pharmacodynamics versus pharmacokinetics of this anticoagulant:  Many statistics from the stroke prevention in atrial fibrillation (SPAF) trial suggest that safety of anticoagulant in the elderly can be maximized through a careful monitoring and maintenance of the INR which is between 2 and 3. Ms. J’s therapeutic window for warfarin 2 to 3 which is the normal range for coumadin therapeutic level. Her weekly dosage is adjusted to her current blood levels. Bleeding is the most related complication of anticoagulant. Amy INR that increasing to 3.4 or 4.0 from Ms. J will result in nose bleeding, decreasing the coumadin or stop it for one or two days will be the only option (Horton & Bushwick, 1999).     Factors influencing Ms. J’s drugs therapy:   Multiple factors may affect the absorption of her medication. For example, the presence or the absence of flood in the stomach, blood flow to the area for absorption, and the dosage form of the drug. In Ms. J’s case, the most critical factor. Influencing her absorption of coumadin is gastric motility due to the history of constipation that she has, while a routine laxative dose and stools softens are administered daily for bowel movement.  Patient-centered care plan for management of constipation:   A non-pharmacologic care plan management can be introduced for the constipation in order to reduce the frequency and the quantity of laxative and stool. Softens doses that Ms. J is getting and ultimately gain a net decrease in gastrointestinal absorption of coumadin. Increasing a dietary fiber in her menu, encourage fluid and prune juice can have a significant impact on her bowel movement (Portalatin & Winstead, 2012).     Portalatin, M., Winstead, N. (2012). Medical Management of Constipation. Clinic in Colon and   Rectal Surgery. Doi: 10.1055/s-0032-1301754. Retrieved from   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348737/  Horton, J. D., Bushwick, B. M. (1999). Warfarin Therapy: Evolving Strategies in Anticoagulation American Family Physician. 59(3):635-646. Retrieved from   https://www.aafp.org/afp/1999/0201/p635.html     Arcangelo, V. P., Peterson, A. M., Wilburg, V., Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach. (4th Ed.). Wolters Kluwer Lippincott Williams &