Health Policy Paper

Assignment 2: Course Project: Health Policy Paper Health policy unfolds daily and drives clin" rel="nofollow">inical practice in" rel="nofollow">in the U.S. You will in" rel="nofollow">investigate current policies or legislation underway for a specific health-related issue and develop a scholarly, APA- formatted paper supported by evidence. The policy paper rubric: you are writin" rel="nofollow">ing on topic the affordable care act. Topic: The Affordable Care ACT all the gradin" rel="nofollow">ing criteria must be covered in" rel="nofollow">in this topc. • Introduction to population or problem (in" rel="nofollow">incidence, prevalence, epidemiology, cost burden, etc.) • Description of how the policy is in" rel="nofollow">intended for a specific population, program, or organization • Specific legislators in" rel="nofollow">involved in" rel="nofollow">in the policy development and dissemin" rel="nofollow">ination • Identify the role of the APRN in" rel="nofollow">in assistin" rel="nofollow">ing with the policy or refutin" rel="nofollow">ing the policy – this requires the evidence to support opin" rel="nofollow">inion, ideas, and/or concepts • Discuss how the policy in" rel="nofollow">influences clin" rel="nofollow">inical practice and is used to promote best outcomes • Examin" rel="nofollow">ine how the policy can be used by the in" rel="nofollow">interprofessional team to ensure coordin" rel="nofollow">inated and comprehensive care for the specific population • Conclusion – summarize fin" rel="nofollow">indin" rel="nofollow">ings 3 pages in" rel="nofollow">in APA format – use of primary peer-reviewed references as much as possible Every topic must be centered in" rel="nofollow">in bold in" rel="nofollow">in the paper (a sample paper layout is provided below). THE PAPER MUST BE WRITTEN ON THE GRADING CRITERIA, All the gradin" rel="nofollow">ing criteria must be covered, in" rel="nofollow">in the topic The Affordable Care Act Gradin" rel="nofollow">ing Criteria Maximum Poin" rel="nofollow">ints Introduced population or problem (in" rel="nofollow">incidence, prevalence, epidemiology, cost burden, etc.). 20 Described how the policy is in" rel="nofollow">intended for a specific population, program, or organization. 20 Involved specific legislators in" rel="nofollow">in the policy development and dissemin" rel="nofollow">ination. 20 Identified the role of the APRN in" rel="nofollow">in assistin" rel="nofollow">ing with the policy or refutin" rel="nofollow">ing the policy. 20 Discussed how the policy in" rel="nofollow">influences clin" rel="nofollow">inical practice and is used to promote best outcomes. 20 Examin" rel="nofollow">ined how the policy can be used by the in" rel="nofollow">interprofessional team to ensure coordin" rel="nofollow">inated and comprehensive care for the specific population. 20 Provided conclusion and summarized fin" rel="nofollow">indin" rel="nofollow">ings. 10 Followed APA format and used primary peer-reviewed references as much as possible. 10 Total: 140 Every statistics and direct quotations must be reference with page numbers EXAMPLE: 1. Accordin" rel="nofollow">ing to Palladin" rel="nofollow">ino and Wade (2010), “a flexible min" rel="nofollow">ind is a healthy min" rel="nofollow">ind” (p. 147). 2. In 2010, Palladin" rel="nofollow">ino and Wade noted that “a flexible min" rel="nofollow">ind is a healthy min" rel="nofollow">ind” (p. 147). 3. In fact, “a flexible min" rel="nofollow">ind is a healthy min" rel="nofollow">ind” (Palladin" rel="nofollow">ino & Wade, 2010, p. 147). 4. “A flexible min" rel="nofollow">ind is a healthy min" rel="nofollow">ind,” accordin" rel="nofollow">ing to Palladin" rel="nofollow">ino and Wade’s (2010, p. 147) longitudin" rel="nofollow">inal study. 5. Palladin" rel="nofollow">ino and Wade’s (2010) results in" rel="nofollow">indicate that “a flexible min" rel="nofollow">ind is a healthy min" rel="nofollow">ind” (p. 147). 6. 7. SAMPLE PAPER 8. 9. Ethical and Legal Issues 10. Jane Doe 11. Every University 12. SU_NSG4070_W1_A3_Doe_J.doc. 13. December 22, 2015 14. Ethical and Legal Issues 15. In this paper the writer will discuss a case study in" rel="nofollow">in which an ethical and legal decisions that will have to be made and the ethical and legal decisions the nurse would make for the patient care. The paper will also discuss the ethical dilemma faced by the family in" rel="nofollow">in makin" rel="nofollow">ing decisions for the patient. Durin" rel="nofollow">ing the process, the paper will also explain" rel="nofollow">in what advice the nurse would give the patient’s concernin" rel="nofollow">ing care family. 16. The Ethical Decisions you would make 17. Accordin" rel="nofollow">ing to data gathered by the nurse, the patient Ann was diagnosed with moderately advanced alzheimer’s disease. The nurse observed because of the disease, the patient is exhibitin" rel="nofollow">ing followin" rel="nofollow">ing symptoms obsessive thin" rel="nofollow">inkin" rel="nofollow">ing, confusion, in" rel="nofollow">inability to recall detail, frustration, and personality changes. The patient also has been diagnosed with pneumonia and has recently unable to communicate and refuse to eat. As a nurse the ethical decision is to provide medically appropriate treatment usin" rel="nofollow">ing evidence-based medicin" rel="nofollow">ine and assess the benefit and burdens in" rel="nofollow">involved. The nurse would adhere to the healthcare in" rel="nofollow">institution’s policies and procedures for ethical decision makin" rel="nofollow">ing regardin" rel="nofollow">ing artificial nutrition. Accordin" rel="nofollow">ing to Burkhardt & Nathaniel (2007), noted that “Nurses are in" rel="nofollow">involved in" rel="nofollow">in patient care situations with moral implications and professionals in" rel="nofollow">in the health care system they make ethical decisions affectin" rel="nofollow">ing life and death. (p. 81). The nurse is also aware that the patient is the predomin" rel="nofollow">inate stakeholder in" rel="nofollow">in this process, and the concern of family, physician, and other providers are what in" rel="nofollow">includes in" rel="nofollow">in the process of makin" rel="nofollow">ing the right choices and decisions of nutrition therapy in" rel="nofollow">intervention in" rel="nofollow">in the patient’s healthcare delivery. 18. The nurse would discuss end-of-life healthcare issues with family while balancin" rel="nofollow">ing the nurse obligation to the patient and implement strategy to elimin" rel="nofollow">inate conflict. The nurse would also educate the family about the benefit of tube feedin" rel="nofollow">ing vs the burden, in" rel="nofollow">inform the family that the purpose of feedin" rel="nofollow">ing and hydration is the restoration of normal function for the patient. The nurse would also educate the family that starvation and dehydration are rather uncomfortable and provision of food and fluids contribute to comfort. The nurse will also in" rel="nofollow">inform the family that it is very difficult and time consumin" rel="nofollow">ing to hand-feed the patient and a feedin" rel="nofollow">ing tube may be the best option and an evaluation of patient progress will be done. Accordin" rel="nofollow">ing to Catlin" rel="nofollow">in (2012), “Ethical train" rel="nofollow">ined nurse understands the decision to in" rel="nofollow">insert an enteral feedin" rel="nofollow">ing tube can have crucial decision for patient family” (p.5). The nurse would also in" rel="nofollow">inform the family that this measure could be temporary and they can refuse tube feedin" rel="nofollow">ing for the patient. But the nurse also believe it is in" rel="nofollow">in this context that most of the controversy might occur. 19. The Legal Decisions you would make 20. The provision of adequate fluid and nutrients in" rel="nofollow">in most in" rel="nofollow">instances example drin" rel="nofollow">inkin" rel="nofollow">ing and eatin" rel="nofollow">ing is necessary and considered by the law as basic care. In adult it acceptable that nutrition by artificial procedures is a medical treatment, in" rel="nofollow">involve professional determin" rel="nofollow">ination and in" rel="nofollow">intervention, governed by the laws related to medical practice. in" rel="nofollow">in 2006, Korner et al, noted that “When certain" rel="nofollow">in situation example persistent vegetative state or there is a conflict between professional decision and wishes of the family, the courts need to in" rel="nofollow">involve before any action taken” (p. 200). Accordin" rel="nofollow">ing to the law patients without capacity circumstances require the nurse to view legal and ethical challenges and make the decisions as the patient would if he or she could speak for themselves. The mechanism to proceed with procedure is the existence of a prior statement about the issue in" rel="nofollow">in a Livin" rel="nofollow">ing Will or other advance care document advance directives. Appoin" rel="nofollow">intment of a healthcare `agent` identify on a healthcare proxy form, legally authorized to make decision based on reasonable evidence of the patient’s wishes. 21. The nurse stated use of other surrogate such as friends and family members which would require clear in" rel="nofollow">instruction of the patient wishes. The nurse would also explain" rel="nofollow">in to the family that a request can be made for artificially provided nutrition can be withdrawn or withheld, if there is no reasonable hope of main" rel="nofollow">intain" rel="nofollow">inin" rel="nofollow">ing life or the artificially nutrition or hydration present extreme burden. The nurse would also educate the family on the patient self-determin" rel="nofollow">ination act (PSDA) of 1990, this federal law require hospitals, nursin" rel="nofollow">ing homes, hospice, HMOs/PPOs and other healthcare facilities who receive Medicare or Medicaid fund to advise patients of their legal rights to refuse treatment if they become unable to speak for themselves and to make advance directives. Accordin" rel="nofollow">ing to Rouse (1991), “Written in" rel="nofollow">information required by the law must be given at the time of the in" rel="nofollow">individual’s admission as an in" rel="nofollow">inpatient” (p. s3). While the law does not answer every question, its underlyin" rel="nofollow">ing assumption is that if in" rel="nofollow">informed, many patients might take advantage of their options. 22. The Nurse Advice to Frank and Sarah 23. Family members Frank and Sara are concern about Ann, they ask if a feedin" rel="nofollow">ing tube is the same as a ventilator. The nurse would advise that a feedin" rel="nofollow">ing tube can’t be remove unless its deem necessary by the doctor, a request by the spouse or family, healthcare proxy form, legally authorized to make decision based on reasonable evidence of the patient’s wishes, or the patient is near death and food and fluids become burdensome. The nurse would explain" rel="nofollow">in to Frank and Sara that pneumonia is an in" rel="nofollow">infection of the lungs and makes it difficult to breathe and cause pain" rel="nofollow">in, confusion and progressive weakness and the use of a ventilator may be used for short period to treat pneumonia. Frank and Sara raise concern about Ann dyin" rel="nofollow">ing of starvation, but seems to also have concern about feedin" rel="nofollow">ing and seems reserve in" rel="nofollow">in allowin" rel="nofollow">ing artificial feedin" rel="nofollow">ing. 24. The nurse would explain" rel="nofollow">in to Frank and Sara that starvation is a long and usually pain" rel="nofollow">inful process that can from 30 to 60 days in" rel="nofollow">in its course. The nurse in" rel="nofollow">informed them also that dyin" rel="nofollow">ing patient who stop takin" rel="nofollow">ing in" rel="nofollow">in food and fluid may not necessarily starve to death, but might be pain" rel="nofollow">inful to see their love suffer. The nurse explain" rel="nofollow">ined that patient who stop absorbin" rel="nofollow">ing fluid and food drift in" rel="nofollow">into a state of unconsciousness and usually between 5 to 8 days when food and fluid is stop. Patient will die several days after. Accordin" rel="nofollow">ing to Ganzin" rel="nofollow">ini (2006), “Data suggest that stoppin" rel="nofollow">ing eatin" rel="nofollow">ing and drin" rel="nofollow">inkin" rel="nofollow">ing in" rel="nofollow">in dyin" rel="nofollow">ing patients causes min" rel="nofollow">inimal sufferin" rel="nofollow">ing, though additional studies are needed” (p. 139). The nurse also in" rel="nofollow">informed the family that durin" rel="nofollow">ing dehydration the body can sustain" rel="nofollow">in itself for no more than two weeks without fluid in" rel="nofollow">intake, unlike starvation, dehydration is not a pain" rel="nofollow">inful experience and with comfort measure in" rel="nofollow">in place, less discomfort is experienced. 25. Frank and Sara are concern if starvation by dyin" rel="nofollow">ing is murder? The nurse would suggest to the family that while this issue raises lots of moral and religious questions, such as euthanasia or word for murder, they the family should look at the patient’s will, the in" rel="nofollow">intention, and the condition of the patient. The nurse suggest the family should seek counsellin" rel="nofollow">ing about their feelin" rel="nofollow">ings on the issue and try to avoid the pain" rel="nofollow">in, anxiety and helplessness. The nurse suggests that because Ann didn’t have advance directive Frank as the husband as the legal right to make decisions for his wife. Without an advance directive, the nurse suggest frank and Sara will be force to choose if nutrition and hydration should be stopped. Without advance directive the family is force to guess what their family member would have wanted and then may face guilt over decision might they make. Accordin" rel="nofollow">ing to Silveira, Kim & Lang (2010), noted that “Patients who had written advance directives received care that was associated with end of life preferences” (p.1211). The nurse noted that raisin" rel="nofollow">ing awareness of the purpose of advance directives is important, and raisin" rel="nofollow">ing professional awareness for the need to respect them is key to improve care provided for the dyin" rel="nofollow">ing patient. 26. Frank and Sara contin" rel="nofollow">inue to question themselves about the right thin" rel="nofollow">ing to do about Ann. The nurse would encourage Frank and Sara to talk with sympathetic friends or family members, who have weathered similar situations, embraced the comfort that you have made the right decision for your family member. The would encourage Frank and Sara to thin" rel="nofollow">ink of what Ann would have wanted and strive to do it. Let the aim be for fin" rel="nofollow">inal days and moments of Ann’s life guided toward main" rel="nofollow">intain" rel="nofollow">in comfort and reachin" rel="nofollow">ing a natural death. 27. Conclusion 28. In this paper Frank and Sara struggles with the decisions about the appropriate care for Ann. They often question themselves about doin" rel="nofollow">ing the right, without advance directives from Ann, the primary course of action is to fulfill Ann’s wishes as she would want it to be. Healthcare professionals such as nurses can play an important role in" rel="nofollow">in guidin" rel="nofollow">ing family to counsellin" rel="nofollow">ing support, privacy, in" rel="nofollow">intimacy, comfort and emotional reassurance durin" rel="nofollow">ing termin" rel="nofollow">inal illness and possible death. 29. 30. 32. References 33. Burkhardt, M. A., & Nathaniel, A. K. (2007). Ethics and issues in" rel="nofollow">in contemporary nursin" rel="nofollow">ing. [VitalSource Bookself Onlin" rel="nofollow">ine]. Retrieved from https://digitalbookshelf.southuniversity.edu/#1111440182/ 34. Catlin" rel="nofollow">in, A. (2012). Feedin" rel="nofollow">ing tube placement. American Journal of Nursin" rel="nofollow">ing, 112(5), 12. http://dx.doi.org/doi:10.1097/01.NAJ.000414298.01556.b8 35. Ganzin" rel="nofollow">ini, L. (2006). Artificial nutrition and hydration at the end of life: Ethics and evidence. Palliative and Supportive Care, 4(2), 135-143. http://dx.doi.org/doi:10.1017/S1478951506060196 36. Korner, U., Bondolfi, A., Buhler, E., McaFie, J., Meguid, M. M., ., .., & Allison, S. P. (2006). Ethical and legal aspects of enteral nutrition. Clin" rel="nofollow">inical Nutrition, 25, 196-202. http://dx.doi.org/doi:10.1016/jcin" rel="nofollow">inu.2006.01.024 37. Rouse, F. (1991). Patients, providers, and the PSDA. The Hastin" rel="nofollow">ing Center Report, 21(5), S2-S3. Retrieved from http://search.proquest.com/ddocview/222366169?accountid=87314 38. Silveira, M. J., Kim, S. Y., & Langa, K. M. (2010). Advance directives and outcomes of surrogate decision makin" rel="nofollow">ing before death. The New England Journal of Medicin" rel="nofollow">ine, 362(13), 1211-1218. http://dx.doi.org/doi:10.1056/NEJMsa0907901 39.