Discussion: Presidential Agendas.

Discussion: Presidential Agendas

Discussion: Presidential Agendas

The healthcare system is highly sensitive and that is why presidents have to make critical decisions and ensure the safety of their citizens. I agree with you that the opioid epidemic is one of the healthcare issues that rose to the presidential level. Opioid misuse presents various health risks and that is why it was necessary to engage the presidential intervention. President Bush’s administration approached the issue in three ways. First, the administration provided efforts to stop the kids from using the drug. Secondly, the treatment for those already using the drug was expanded and finally, the flow of the drug into America was controlled. The measure would be undertaken for infectious diseases that arise, Breaking the infection cycle is important in managing health crises and emergencies (Hedberg, et al., 2019).

The Obama administration approached the issue more comprehensively and approved the CAR bill to fight the epidemic. Similarly, President Donald Trump declared the epidemic a national state of emergency and this was appropriate. I agree that health issues require urgent intervention to curb the causative factors and prevent the issue from spreading further and this is what the three presidential administrations did.

The presidents must be sensitive to identify the impacts of given health issues and develop appropriate policies that will minimize the harmful effects the citizens suffer (Smith, 2020). In this case, the use of opioid drugs was on the rise and the level could have been very disastrous if the relevant measures developed were not adopted. It is important that government systems set aside funds to handle medical emergencies whenever they rise because they cannot be postponed (Katz, Attal-Juncqua & Fischer, 2017).

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Discussion: Presidential Agendas References

Hedberg, K., Bui, L. T., Livingston, C., Shields, L. M., & Van Otterloo, J. (2019). Integrating public health and health care strategies to address the opioid epidemic: the Oregon Health Authority’s Opioid Initiative. Journal of Public Health Management and Practice25(3), 214-220. doi: 10.1097/PHH.0000000000000849.

Katz, R., Attal-Juncqua, A., & Fischer, J. E. (2017). Funding public health emergency preparedness in the United States. American journal of public health107(S2), S148-S152. doi: 10.2105/AJPH.2017.303956

Smith, H. J. (2020). Ethics, Public Health, and Addressing the Opioid Crisis. AMA Journal of Ethics22(8), 647-650. doi: 10.1001/amajethics.2020.647.

The population health topic I am choosing is the opioid epidemic. I chose this because it affects such a large population in today’s world. According to the Centers for Disease Control and Prevention (2022), drug overdose deaths have increased by nearly 5% from 2018 to 2019 and quadrupled since 1999. Over 70% of the 70,630 deaths in 2019 involved an opioid. In 2020, 91,799 drug overdose deaths occurred in the United States. The number continues to rise, and drugs seem to be more accessible.

Regarding social determinants, people from low socio-economic classes have poorer health. They are more likely to use tobacco, drink alcohol at high risk, and use illicit drugs. Drug-dependent people are particularly likely to be unemployed and to experience marginalization, both of which can exacerbate their problems and prevent seeking or benefiting from treatment (Spooner,2017). Drug abuse is not shy when it comes to whom it affects. People in low socioeconomic classes happen to get slammed with drug abuse as we have not provided the right accessibility for them.

One of President Trump’s solutions was to build a wall. Theoretically, the wall would stop illegal drugs from coming in, and this wall was supposed to be built on the Mexican border. He also said he would enhance access to addiction services, end Medicaid policies that obstruct inpatient treatment, and expand incentives for state and local governments to use drug courts and mandated treatment to respond to the addiction crisis (Kaiser Family Foundation,2017). Although some think the wall may help, it is not the solution to the epidemic. In some cases, working from the outside inward works, but in this case, I think this epidemic needs to be approached from the inside out.

In this case, I would have started the solution on the inside. I would have targeted what we can control right now. Stopping Illegal drugs from coming in will help in the long run, but you must focus on what illegal drugs are happening in the US. Building a wall doesn’t stop the use, trading, selling, or buying we are currently dealing with. I would work to eliminate those issues, do more research on who this affects the most, and start there. We know people from low socio-economic classes struggle the most, so I start there and work my way out. Maybe we start focusing on getting these people out of this low-income rut. We provide schooling, daycare, and opportunities some people will never receive. Even starting there seems small, but I would further it with Trump’s plan to enhance access to drug addiction services like counselors. I would hold more doctors accountable and pharmaceutical companies pushing these opioids for money.

According to the Democrat National Committee (2020), President Biden’s solution includes holding people accountable such as big pharmaceutical companies, executives, and others, responsible for their role in triggering the opioid crisis. Biden will create effective prevention, treatment, and recovery services available to all through a $125 billion federal investment. Most importantly, we will stop overprescribing pain medication to citizens. I think Biden’s solutions to this epidemic were much better; these solutions start inward and target the people in the US struggling. I believe the solutions listed will help the country see a decline in opioid deaths, but they won’t solve the issue altogether.

As much as I agree with this approach, I don’t think the primary producers of these drugs are being held accountable enough. I would figure out a way other than fines to serve these companies. Possibly suspending their production may be a helping solution. The problem is these companies are laced with money, so half the time, they don’t even blink at the request to hand over money due to fines. I wouldn’t change much to Biden’s policy otherwise. I think his approach gives people accessibility, and that’s truly what we need to end this epidemic.

Centers for Disease Control and Prevention (2022). Death Rate Maps & Graphs. Centers for Disease Control and Prevention. Retrieved August 30, 2022, from https://www.cdc.gov/drugoverdose/deaths/index.html

Democrat National Committee. (2020). The Biden plan to end the opioid crisis. Joe Biden for President: Official Campaign Website. Retrieved August 30, 2022, from https://joebiden.com/opioidcrisis/

Kaiser Family Foundation. (2017, January 9). President-elect Donald Trump stands on six health care issues – election 2016: The issues. KFF. Retrieved August 30, 2022, from https://www.kff.org/report-section/where-president-elect-donald-trump-stands-on-six-health-care-issues/#opioid

Spooner, C.  (2017). SOCIAL DETERMINANTS OF DRUG USE. National Drug and Alcohol Research Centre (NDARC). Retrieved August 30, 2022, from https://ndarc.med.unsw.edu.au/

Regardless of political affiliation, every citizen has a stake in healthcare policy decisions. Hence, it is little wonder why healthcare items become such high-profile components of presidential agendas. It is also little wonder why they become such hotly debated agenda items.

Consider a topic that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently?

To Prepare:

  • Review the Resources and reflect on the importance of agenda setting.
  • Consider how federal agendas promote healthcare issues and how these healthcare issues become agenda priorities.

By Day 3 of Week 1

Post your response to the discussion question: Consider a topic that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently?

Click here to ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Discussion: Presidential Agendas

RE: Discussion – Week 1

Policies, Problems, and Planning to Reach Rural Veterans

Suicide accounts for 8.3% of deaths among U.S. adults, and Veterans alone represent an unignorable 14.3% of these tragedies (Department of Veterans Affairs [VA], 2018). Consequently, death by suicide for the veteran patient population is 1.5 times the rate of non-veteran sufferers (VA, 2018). Our current and previous presidential administrations have contributed to the funding and development of veteran suicide research and interventions. Since the inception of the Veterans Access, Choice and Accountability Act (CHOICE Act) of 2014, veteran suicide data and research has enabled policy makers to focus on reaching veterans living in rural areas.  Veterans living in rural areas account for nearly one fourth of the veteran population (VA,2018). Veterans living in rural areas have a 20%-22% greater risk of death by suicide in comparison to veterans living in urban areas. According to the Veterans Affairs Office of Rural Health, 4.7 million veterans return from active military careers to live in rural areas, only 2.5 million are enrolled to receive VA health care services, and far more than half of enrolled veterans living in rural areas have service-connected disabilities (VA.gov: Veterans Affairs 2016).

In 2014, President Barrack Obama and Senator John McCain III set the groundwork for veteran mental health care reform with the passage of the Veterans Access, Choice and Accountability Act (CHOICE Act) of 2014. With this act, veterans in rural areas had expanded options to receive care from non-VA providers with the VHA’s coordination and approval. The CHOICE Act also highlighted health care staffing disparities via staff shortage reports required by the VA Office of Inspector General, and the identification of the need to increase Graduate Medical Education (GME) residency positions in the mental health specialty.

The Choice Act was further amended in 2016 with the passing of the Jeff Miller and Richard Blumentha Veterans Heath Care and Benefits Improvement Act to further increase the number of GME residency positions over 10 years instead of five and extended the program to 2024 (Albanese et al., 2019). Despite the increase in GME residency positions and extensions of program funding, health care disparities in rural areas continued their negative trend. At this point, veteran advocates and policy makers identified the physician shortage gap in rural areas as a mission-critical priority for the VHA and began working towards the John S McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal System and Strengthening Integrated Outside Networks (MISSION) Act of 2018.

In June 2018, the Obama administrations groundwork for the MISSION Act paved the way for the Trump Administration to see it through to fruition. With the problem stream of rural access leading policy formation, the MISSION Act created interventions based on physician shortages that now determine location, specialty, and amount GME residency positions within outlined parameters. Essentially focus has shifted from interventions to bring veterans to health care providers (HCP), to interventions to bring HCP to veterans. These interventions include expanding VA Health Care Profession Scholarships (HPSP) to graduate education for nurse practitioners select, who are allowed to practice at their full scope of practice without physician supervision. These expansions will increase patient access to quality health care and improve staffing shortages in rural veteran communities (American Association of Colleges of Nursing [AACN], 2016). In addition to GME improvements, veterans now could seek medical assistance from non-VA facilities without penalty when in need.

Most recently, the Biden Administration passed the Sgt. Ketchum Rural Veterans Mental Health Act of 2021. This bill was created in honor of its name’s sake, Sergent Brandon Ketchum, in addition to many other sailors, marines, and soldiers who lost their battles with suicidal ideation in the face of limited access to care.  Sgt. Ketchum was a 33-year-old Operation Iraqi Freedom Veteran who served in Iraq and Afghanistan struggled with post-traumatic stress disorder and substance abuse after returning home to a rural area in Iowa. In 2016 he presented to the Iowa City VA Hospital where he asked to be admitted before the psychiatrist determined inpatient care was not needed at the time. Brandon returned home and committed suicide that night. An investigation was completed and no HCP’s were found to be directly responsible for his death; however, quality patient education on suicidal ideation, risk factor ratings, and access to routine outpatient psychiatric mental health services or the lack there of could be at fault.  Under this bill, rural veterans diagnosed with Schizophrenia, Schizoaffective Disorder, Bipolar Affective Disorder, Major Depression, PTSD, and any severe or chronic mental health condition will have access to Rural Access Network for Growth Enhancement (RANGE) programs (Veterans Health Administration, VA.gov: Veterans Affairs 2013). The RANGE program provides intensive case management to veterans with serious mental illness who are experiencing homelessness or who are at risk of experiencing homelessness with an emphasis on recovery. The Sgt. Ketchum Rural Veterans Mental Health Act of 2021 bill also requires the government to conduct a study and report on whether the VA has adequate resources to provide services to rural veterans whose lives depend on mental health care the is more intensive than traditional outpatient therapy (Monteith et al., 2020).

Unfortunately, VA healthcare reform is faced with similar challenges of establishing universal health care but on a smaller scale. Agendas, interest groups, insurance stakeholders, pharmaceutical suppliers, and access to care are all variables in creating policies that appear to be relentless barriers to healthcare reform; however, change is a process. The evolution of the CHOICE act to the Sgt. Ketchum Rural Veterans Mental Health Act of 2021 is promising. Findings from this living body of veteran health data and research will continue to shape policy improvement. I am hopeful that with each future bill and amendment passed, a new layer of protection will be provided to those who have sacrificed their lives to protect us.

Discussion: Presidential Agendas References

Albanese, A. P., Bope, E. T., Sanders, K. M., & Bowman, M. (2019). The VA mission act of 2018: A potential game changer for rural GME expansion and Veteran health care. The Journal of Rural Health, 36(1), 133–136. https://doi.org/10.1111/jrh.12360

American Association of Colleges of Nursing. (2016, December 13). VA ruling on APRN practice: a breakthrough for veterans health care. Message posted on the American Association of Colleges of Nursing Listserv:[email protected]

Department of Veterans Affairs (2018b). VA National Suicide Data Report: 2005–2015. Retrieved from

https://www.mentalhealth.va.gov/ docs/data-sheets/OMHSP_National_Suicide_Da ta_Report_2005-2015_06-14-18_508-compliant.pdf

Monteith, L. L., Wendleton, L., Bahraini, N. H., Matarazzo, B. B., Brimner, G., & Mohatt, N. V. (2020). Together with veterans: Va national strategy alignment and lessons learned from community‐based suicide prevention for rural veterans. Suicide and Life-Threatening Behavior, 50(3), 588–600. https://doi.org/10.1111/sltb.12613

VA.gov: Veterans Affairs. RURAL VETERANS. (2016, January 19).

https://www.ruralhealth.va.gov/aboutus/ruralvets.asp.

Veterans Health Administration, D. U. S. for O. and M. (2013, May 8). VA.gov: Veterans Affairs. Enhanced RANGE Program. https://www.lexington.va.gov/services/Enhanced_RANGE_Program.asp.

RE: Discussion – Week 1

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Top of Form

Many people living in the united states and the world in general are having one or two mental health illnesses that are neglected such as stress, depression and emotional distress. Mental health patients are at high risk for sudden death. Shortage of mental health resources and facilities is a problem. I will be looking on how President Bush, Obama, and Trump made some reforms to improve these mental health patients.

George Bush the 43rd president of the United States of America saw the need for improving mental health care that is why he created the New Commission that was made of mental health experts who came up with 19 recommendation to improve mental illness for adult, youth and children (National Alliance for Mental Health (NAMH), 2021). This reduces the way people treated mentally ill. More so the President also sign an act which provided resources to prevent mentally ill patient from been imprison. President Bush prevented the co-occurring of substance used. Another act that was sign in 2008 was that which provided equality in health insurance the mentally ill and a medical patient. (NAMH, 2021)

Barack Obama the 44th President sign the patient protection and Affordable Care Act (ACA) which added mental health patients to Medicaid, making uninsured patients to be insured.   In 2010, President Obama provided an act for supportive resources for patients with mental health. National conference for mental health in 2013 with dialogue on mental health. Was created by Obama  More so President Obama provided a budget of 500million to be invested in mental health care. Obama sign an act called the clay hunt suicide prevention which was in favor of the veteran who suffer mental diseases and needed help this act provided immediate action in the favor (White House, 2016).

During President Trump reign he supported community health clinic for mentally ill  with 700million dollars for the community mental health. Around 100million was allocated for children with mental illness. He went ahead and reduce funding’s for substance abuse (National Council for Behavioral health, 2020) More, so he fought for the affordable care act that prevented mental health patients from the care they need.

My passion has always looking for opportunities to impact others wherever need arises I realized that there are so many individuals that we interact each day with mental problems but due to stigmatism are scared to seek medical attention.  It is amazing how many of my friends and family members suffers from depression and anxiety.   As nurse I realized that am ethically responsible to advocate and be the change agent in my family, community, and the world as a whole.

Discussion: Presidential Agendas References

National Alliance for Mental Health, (2021).  How President have shaped mental health care

https://www.nami.org/Blogs/NAMI-Blog/February-2016/How-Presidents-Have-Shaped-Mental-Health-Care

National Council for Behavioral Health. (2020). President Trump releases fiscal year 2020 budget proposalHttps://www.thenationalcouncil.org/capitol-connector/2019/03/president-trump-releases-fy-2020-budget-proposal/

The White House. (2016). Making healthcare better. Addressing mental health: Progress in research, prevention, coverage, recovery and quality.https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Documents/MentalHealthReport.pdf

Learning Resources
Required Readings

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.).
Burlington, MA: Jones & Bartlett Learning.
 Chapter 1, “Informing Public Policy: An Important Role for Registered Nurses” (pp.
11–13 only)
 Chapter 2, “Agenda Setting: What Rises to a Policymaker’s Attention?” (pp. 17–36)
 Chapter 10, “Overview: The Economics and Finance of Health Care” (pp. 171–180)
 Chapter 12, “An Insider’s Guide to Engaging in Policy Activities”
o “Creating a Fact Sheet” (pp. 217-221) Discussion: Presidential Agendas.

DeMarco, R., & Tufts, K. A. (2014). The mechanics of writing a policy brief. Nursing Outlook,
62(3), 219–224. doi:10.1016/j.outlook.2014.04.002

Kingdon, J.W. (2001). A model of agenda-setting with applications. Law Review M.S.U.-D.C.L.,
2(331)

Lamb, G., Newhouse, R., Beverly, C., Toney, D. A., Cropley, S., Weaver, C. A., Kurtzman, E.,
… Peterson, C. (2015). Policy agenda for nurse-led care coordination. Nursing Outlook, 63(4),
521–530. doi:10.1016/j.outlook.2015.06.003.

O’Rourke, N. C., Crawford, S. L., Morris, N. S., & Pulcini, J. (2017). Political efficacy and
participation of nurse practitioners. Policy, Politics, and Nursing Practice, 18(3), 135–148.
doi:10.1177/1527154417728514

Institute of Medicine (US) Committee on Enhancing Environmental Health Content in Nursing
Practice, Pope, A. M., Snyder, M. A., & Mood, L. H. (Eds.). (n.d.). Nursing health, &
environment: Strengthening the relationship to improve the public's health.

USA.gov. (n.d.). A-Z index of U.S. government departments and agencies. Retrieved September
20, 2018, from https://www.usa.gov/federal-agencies/a

USA.gov. (n.d.). Executive departments. Retrieved September 20, 2018, from
https://www.usa.gov/executive-departments

The White House. (n.d.). The cabinet. Retrieved September 20, 2018, from
https://www.whitehouse.gov/the-trump-administration/the-cabinet/

Document: Agenda Comparison Grid Template (Word document)

Module 1: Agenda Setting (Weeks 1-2)

Laureate Education (Producer). (2018). Meet the Experts: Pioneers in Policy [Video file]. Baltimore, MD: Author.

Laureate Education (Producer). (2018). The Policy Process [Video file]. Baltimore, MD: Author.
Learning Objectives
Students will:

Compare U.S. presidential agenda priorities

Evaluate ways that administrative agencies help address healthcare issues
Analyze how healthcare issues get on administrative agendas
Identify champions or sponsors of healthcare issues
Create fact sheets for communicating with policymakers or legislators
Justify the role of the nurse in agenda setting for healthcare issues

Due By
Assignment
Week 1, Days 1–2
Read/Watch/Listen to the Learning Resources.
Compose your initial Discussion post.
Week 1, Day 3
Post your initial discussion post.
Week 1, Days 4-5
Review peer Discussion posts.
Compose your peer Discussion responses.
Begin to compose your Assignment.
Week 1, Day 6
Post at least two peer Discussion responses on two different days (and not the same day as the initial post).
Continue to compose your final draft of your Assignment.
Week 1, Day 7
Wrap up Discussion.
Week 2, Day 1–6
Continue to compose your Assignment.
Week 2, Day 7
Deadline to submit your Assignment.

Learning Resources

Required Readings

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

Chapter 1, “Informing Public Policy: An Important Role for Registered Nurses” (pp. 11–13 only)
Chapter 2, “Agenda Setting: What Rises to a Policymaker’s Attention?” (pp. 17–36)
Chapter 10, “Overview: The Economics and Finance of Health Care” (pp. 171–180)
Chapter 12, “An Insider’s Guide to Engaging in Policy Activities”
“Creating a Fact Sheet” (pp. 217-221) Discussion: Presidential Agendas.

DeMarco, R., & Tufts, K. A. (2014). The mechanics of writing a policy brief. Nursing Outlook, 62(3), 219–224. doi:10.1016/j.outlook.2014.04.002

Kingdon, J.W. (2001). A model of agenda-setting with applications. Law Review M.S.U.-D.C.L., 2(331)

Lamb, G., Newhouse, R., Beverly, C., Toney, D. A., Cropley, S., Weaver, C. A., Kurtzman, E., … Peterson, C. (2015). Policy agenda for nurse-led care coordination. Nursing Outlook, 63(4), 521–530. doi:10.1016/j.outlook.2015.06.003.

O’Rourke, N. C., Crawford, S. L., Morris, N. S., & Pulcini, J. (2017). Political efficacy and participation of nurse practitioners. Policy, Politics, and Nursing Practice, 18(3), 135–148.

Institute of Medicine (US) Committee on Enhancing Environmental Health Content in Nursing Practice, Pope, A. M., Snyder, M. A., & Mood, L. H. (Eds.). (n.d.). Nursing health, & environment: Strengthening the relationship to improve the public’s health.

USA.gov. (n.d.). A-Z index of U.S. government departments and agencies. Retrieved September 20, 2018, from https://www.usa.gov/federal-agencies/a

USA.gov. (n.d.). Executive departments. Retrieved September 20, 2018, from https://www.usa.gov/executive-departments

The White House. (n.d.). The cabinet. Retrieved September 20, 2018, from https://www.whitehouse.gov/the-trump-administration/the-cabinet/

Each year in the U.S., millions of people are affected by mental illness. The CDC reports that 50% of Americans will at one time in their life be diagnosed with a mental disorder (CDC, 2019). As nurses, we must understand the physical, social and financial impact mental health has on our nation. We must raise awareness, reduce the negative stigma, and advocate for better health care.

I focused my post on mental health care because it is my nursing specialty. After reviewing what the last three presidents have accomplished, I was surprised and pleased with president Bush’s and Obama’s attempts to address mental health; however, I was disappointed in President Trump’s apparent lack of support.

In 2002 President Bush created the New Freedom Commission Act, which would improve mental health services for children, adolescents, and adults by coordinating treatments and services to promote their successful integration into the community (President`s New Freedom Commission on Mental Health, 2019). His support for mental health didn’t stop there. Throughout his presidency, he continued to make positive changes for those living with mental illness. In his final year as president, he signed an act establishing health insurance coverage for people with mental health disorders, seeing it as just as important as physical health (Hart, 2016). Two years later, under the Obama administration, President Obama signed the Patient Protection and Affordable Care Act, much like Bush, demonstrating that mental health is as important as physical health. In 2016, the president proposed a budget that included a new $500 million investment to increase access to mental health care (Hart, 2016). As stated above, both Presidents acknowledged mental health and the importance of treating it as equal to physical health. Conversely, during his time in office, President Trump advocated for the reduction in Medicaid funding to each state, which directly impacted the mental health services to the aged and disabled who qualified under this program (The Trump Administration and Mental Health, 2018).

If I were to do anything different, I would have built on the legacy of Bush and Obama to increase awareness, policies, and funds to address mental health. Mental health issues are not going away, and decreasing funding for programs that meet the needs of the mentally ill is a step in the wrong direction.

Required Media

Laureate Education (Producer). (2018). Setting the Agenda [Video file]. Baltimore, MD: Author.

Required Media
Laureate Education (Producer). (2018). Setting the Agenda [Video file]. Baltimore, MD: Author.

Discussion: Presidential Agendas Rubric Detail

Select Grid View or List View to change the rubric’s layout.
Content
Name: NURS_6050_Module01_Week01_Discussion_Rubric

Grid View
List View

Excellent Good Fair Poor
Main Posting

Points Range: 45 (45%) – 50 (50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 40 (40%) – 44 (44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. Discussion: Presidential Agendas.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 35 (35%) – 39 (39%)

Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range: 0 (0%) – 34 (34%)

Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
Points Range: 10 (10%) – 10 (10%)
Posts main post by day 3.

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)
Does not post by day 3.
First Response

Points Range: 17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.

Points Range: 15 (15%) – 16 (16%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 13 (13%) – 14 (14%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 12 (12%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Second Response

Points Range: 16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.

Points Range: 14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 12 (12%) – 13 (13%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Participation

Points Range: 5 (5%) – 5 (5%)

Meets requirements for participation by posting on three different days.

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)

Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
Name: NURS_6050_Module01_Week01_Discussion_Rubric

RE: Discussion – Week 1

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Policies, Problems, and Planning to Reach Rural Veterans

Suicide accounts for 8.3% of deaths among U.S. adults, and Veterans alone represent an unignorable 14.3% of these tragedies (Department of Veterans Affairs [VA], 2018). Consequently, death by suicide for the veteran patient population is 1.5 times the rate of non-veteran sufferers (VA, 2018). Our current and previous presidential administrations have contributed to the funding and development of veteran suicide research and interventions. Since the inception of the Veterans Access, Choice and Accountability Act (CHOICE Act) of 2014, veteran suicide data and research has enabled policy makers to focus on reaching veterans living in rural areas.  Veterans living in rural areas account for nearly one fourth of the veteran population (VA,2018). Veterans living in rural areas have a 20%-22% greater risk of death by suicide in comparison to veterans living in urban areas. According to the Veterans Affairs Office of Rural Health, 4.7 million veterans return from active military careers to live in rural areas, only 2.5 million are enrolled to receive VA health care services, and far more than half of enrolled veterans living in rural areas have service-connected disabilities (VA.gov: Veterans Affairs 2016).

In 2014, President Barrack Obama and Senator John McCain III set the groundwork for veteran mental health care reform with the passage of the Veterans Access, Choice and Accountability Act (CHOICE Act) of 2014. With this act, veterans in rural areas had expanded options to receive care from non-VA providers with the VHA’s coordination and approval. The CHOICE Act also highlighted health care staffing disparities via staff shortage reports required by the VA Office of Inspector General, and the identification of the need to increase Graduate Medical Education (GME) residency positions in the mental health specialty.

The Choice Act was further amended in 2016 with the passing of the Jeff Miller and Richard Blumentha Veterans Heath Care and Benefits Improvement Act to further increase the number of GME residency positions over 10 years instead of five and extended the program to 2024 (Albanese et al., 2019). Despite the increase in GME residency positions and extensions of program funding, health care disparities in rural areas continued their negative trend. At this point, veteran advocates and policy makers identified the physician shortage gap in rural areas as a mission-critical priority for the VHA and began working towards the John S McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal System and Strengthening Integrated Outside Networks (MISSION) Act of 2018.

In June 2018, the Obama administrations groundwork for the MISSION Act paved the way for the Trump Administration to see it through to fruition. With the problem stream of rural access leading policy formation, the MISSION Act created interventions based on physician shortages that now determine location, specialty, and amount GME residency positions within outlined parameters. Essentially focus has shifted from interventions to bring veterans to health care providers (HCP), to interventions to bring HCP to veterans. These interventions include expanding VA Health Care Profession Scholarships (HPSP) to graduate education for nurse practitioners select, who are allowed to practice at their full scope of practice without physician supervision. These expansions will increase patient access to quality health care and improve staffing shortages in rural veteran communities (American Association of Colleges of Nursing [AACN], 2016). In addition to GME improvements, veterans now could seek medical assistance from non-VA facilities without penalty when in need.

Most recently, the Biden Administration passed the Sgt. Ketchum Rural Veterans Mental Health Act of 2021. This bill was created in honor of its name’s sake, Sergent Brandon Ketchum, in addition to many other sailors, marines, and soldiers who lost their battles with suicidal ideation in the face of limited access to care.  Sgt. Ketchum was a 33-year-old Operation Iraqi Freedom Veteran who served in Iraq and Afghanistan struggled with post-traumatic stress disorder and substance abuse after returning home to a rural area in Iowa. In 2016 he presented to the Iowa City VA Hospital where he asked to be admitted before the psychiatrist determined inpatient care was not needed at the time. Brandon returned home and committed suicide that night. An investigation was completed and no HCP’s were found to be directly responsible for his death; however, quality patient education on suicidal ideation, risk factor ratings, and access to routine outpatient psychiatric mental health services or the lack there of could be at fault.  Under this bill, rural veterans diagnosed with Schizophrenia, Schizoaffective Disorder, Bipolar Affective Disorder, Major Depression, PTSD, and any severe or chronic mental health condition will have access to Rural Access Network for Growth Enhancement (RANGE) programs (Veterans Health Administration, VA.gov: Veterans Affairs 2013). The RANGE program provides intensive case management to veterans with serious mental illness who are experiencing homelessness or who are at risk of experiencing homelessness with an emphasis on recovery. The Sgt. Ketchum Rural Veterans Mental Health Act of 2021 bill also requires the government to conduct a study and report on whether the VA has adequate resources to provide services to rural veterans whose lives depend on mental health care the is more intensive than traditional outpatient therapy (Monteith et al., 2020).

Unfortunately, VA healthcare reform is faced with similar challenges of establishing universal health care but on a smaller scale. Agendas, interest groups, insurance stakeholders, pharmaceutical suppliers, and access to care are all variables in creating policies that appear to be relentless barriers to healthcare reform; however, change is a process. The evolution of the CHOICE act to the Sgt. Ketchum Rural Veterans Mental Health Act of 2021 is promising. Findings from this living body of veteran health data and research will continue to shape policy improvement. I am hopeful that with each future bill and amendment passed, a new layer of protection will be provided to those who have sacrificed their lives to protect us.

Discussion: Presidential Agendas References

Albanese, A. P., Bope, E. T., Sanders, K. M., & Bowman, M. (2019). The VA mission act of 2018: A potential game changer for rural GME expansion and Veteran health care. The Journal of Rural Health, 36(1), 133–136. https://doi.org/10.1111/jrh.12360

American Association of Colleges of Nursing. (2016, December 13). VA ruling on APRN practice: a breakthrough for veterans health care. Message posted on the American Association of Colleges of Nursing Listserv:[email protected]

Department of Veterans Affairs (2018b). VA National Suicide Data Report: 2005–2015. Retrieved from

https://www.mentalhealth.va.gov/ docs/data-sheets/OMHSP_National_Suicide_Da ta_Report_2005-2015_06-14-18_508-compliant.pdf

Monteith, L. L., Wendleton, L., Bahraini, N. H., Matarazzo, B. B., Brimner, G., & Mohatt, N. V. (2020). Together with veterans: Va national strategy alignment and lessons learned from community‐based suicide prevention for rural veterans. Suicide and Life-Threatening Behavior, 50(3), 588–600. https://doi.org/10.1111/sltb.12613

VA.gov: Veterans Affairs. RURAL VETERANS. (2016, January 19).

https://www.ruralhealth.va.gov/aboutus/ruralvets.asp.

Veterans Health Administration, D. U. S. for O. and M. (2013, May 8). VA.gov: Veterans Affairs. Enhanced RANGE Program. https://www.lexington.va.gov/services/Enhanced_RANGE_Program.asp.

I agree with you that most people living the US and the world have had mental illness at one stage of their lives. It is absolutely true that most communities have neglected mental illness such as emotional distress, depression, and stress. Unexpected and sudden death is common among mental health patients. Persons with mental illness are known to have poor health status and considerable premature mortality. I concur with my colleague that the previous presidents, George W Bush, Barrack Obama, and Donald Trump, have made fundamental reforms to reduce the number of mental health patients in America. Bush created a commission that come up with 19 impressive recommendations to reduce mental illness. His successor, Obama, signed ACA that added mental health patients to Medicaid. Lastly, Trump supported a group of health clinics for mentally ill patients with US$700 million.

Mental health disorders affect a person’s feeling, thinking, mood, or behavior, such as anxiety, depression, panic disorder, prevalence, schizophrenia, or bipolar disorder (Valentine, & Shipherd, 2018). These conditions may either be chronic (long-lasting) or occasional, affecting the person’s ability to perform their daily activities. In 2019, nearly 21% of Americans had a mental illness. The number signifies that 1 in 5 Americans experienced mental health disorders in 2019 (Czeisler et al., 2020). Mental health disorder does not discriminate, and it can affect all people regardless of their social status, income, geography, age, sexual orientation, ethnicity/race, or spirituality/religion. Unfortunately, people who are mentally ill do not want to talk about it. There is nothing to be ashamed of about this condition; it is a medical condition like diabetes, cancer, or cardiovascular diseases. Most mental disorders disorders are treatable.

Discussion: Presidential Agendas References

Czeisler, M. É., Lane, R. I., Petrosky, E., Wiley, J. F., Christensen, A., Njai, R., … & Rajaratnam, S. M. (2020). Mental health, substance use, and suicidal ideation during the COVID-19 pandemic—United States, June 24–30, 2020. Morbidity and Mortality Weekly Report69(32), 1049. Doi: doi: 10.15585/mmwr.mm6932a1

Valentine, S. E., & Shipherd, J. C. (2018). A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clinical Psychology Review66, 24-38. Doi: 10.1016/j.cpr.2018.03.003

In 2020, the Centers for Disease Control and Prevention (CDC) reported that nearly 75% of the 91,799 drug overdose deaths in 2020 involved an opioid, with an increase in prescription opioid-involved and synthetic opioid-involved death rates than precious years (Centers for Disease Control and Prevention, n.d.). The opioid epidemic started with the first wave in the 1990s with an overly prescription opioid. Now it has evolved into the fourth wave of synthetic opioid use. We are going into almost fifty years of this epidemic with a steady increase in opioid use and deaths. I have worked for the past eight years in the emergency department. I have seen firsthand the effects of opioid addictions on patients, their families and friends, first responders, healthcare workers, and the community. 

All five social determinants of health are affected by the opioid epidemic. However, neighborhoods/built environment and health care access/quality objectives are most involved. Neighborhoods and built environments are affected by the opioid epidemic because communities with high rates of opioid use have increased violence and increased risk of continued opioid use from generation to generation. It becomes a vicious repeating cycle. Health care access and quality objectives are affected because untreated addicts cannot access treatment, support, or the resources to overcome the addiction. 

Past President’s Approaches 

On October 26, 2017, Former President Trump declared the opioid epidemic a nationwide public health emergency. President Trump’s approaches provided an education campaign, “Stop Opioid Abuse.” A portion of the campaign target to stop youth opioid abuse. He implemented the Safer Prescribing Plan to decrease opioid prescriptions. Also, he reduced the supply of illicit drugs by securing ports of entry to America and increasing the death penalty against drug traffickers. Lastly, his approach was to aid people struggling with addiction with recovery support services and evidence-based treatments. Trump had mild, short-lived success with this action plan. His success was that first-time heroin users aged 12 and older fell by 50%, opioid prescriptions dropped by 16%, and he was able to shut down the country’s biggest Darknet distributor of drugs. He had a 20 % increase in young adults receiving outpatient treatment. However, this placed a band-aid on this opioid crisis (The White House, n.d.). 

President Biden’s approach is the National Drug Control Strategy, that primary forces on untreated addiction and drug trafficking. For untreated addiction, Biden is giving a $1.5 billion funding opportunity to a State Opioid Response Grant Program through Substance Abuse and Mental Services (SAMHSA). This provision aims to provide education and resources to expand high-impact harm interventions like naloxone treatment, ensure access to evidence-based practice treatment and improve data systems and research that guide drug research. Each state must complete an application to qualify for this funding (The White House, 2022). 

 In the grant application, this funding will hold the states that receive it accountable and limit how much of the budget can go to the staff members’ salaries in this program (Substance Abuse and Mental Health Services Administration, n.d.). This step is an excellent measure to ensure that most of the funding goes to the patients. Biden’s plan to stop drug trafficking is to increase drug enforcement administration to obstruct and disrupt financial activities of manufacture and trafficking of illicit drugs in America and to reduce the supply smuggled across our border (The White House, 2022). I am very interested to see the results of the National Drug Control Strategy. It can be very successful because it holds each state accountable for this funding. I wish this were a mandatory program for each state participating. 

What could be Done Differently 

I think combining both presidents’ approaches would help handle the opioid epidemic. I like Trump’s focus on education for youth. I would want to push the education campaign into a school program that is a 30-minute weekly class or activity related to the dangers of opioid use that will be mandatory for students to complete starting in upper elementary to high school. I agree with the structure of Biden’s approach. I would want to see the initial outcome of the States that applied for the State Opioid Response Grant Program and the accountability held by the SAMHSA for these programs before I try to alter this approach. I think the most critical interventions for the opioid epidemic are education and having the resources and treatments available to the people that need them in a timely matter. 

  

References 

Centers for Disease Control and Prevention. Understanding the Opioid Overdose Epidemic | CDC. Retrieved August 29, 2022, from https://www.cdc.gov/opioids/basics/epidemic.html 

Substance Abuse and Mental Health Services Administration. Application Forms and Resources | SAMHSA. Retrieved August 29, 2022, from https://www.samhsa.gov/grants/applying/forms-resources 

The White House ,. Ending America’s Opioid Crisis. Retrieved August 29, 2022, from https://trumpwhitehouse.archives.gov/opioids/ 

The White House. (2022, April 21). FACT SHEET: White House Releases 2022 National Drug Control. Retrieved August 30, 2022, from https://www.whitehouse.gov/briefing-room/statements-releases/2022/04/21/fact-sheet-white-house-releases-2022-national-drug-control-strategy-that-outlines-comprehensive-path-forward-to-address-addiction-and-the-overdose-epidemic/ 

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