Discussion: The Role Of The RN/APRN In Policy Evaluation NURS 6050

Discussion: The Role of the RN/APRN in Policy Evaluation NURS 6050

Healthcare policies are a collection of decisions, goals, and actions created to positively impact the health and wellbeing of the community. The scope of policies can be as small as teams within a healthcare institution to as broad as the entire nation. Nurses learn policies to enable them to increase positive outcomes during the process of care. For instance, they may reduce the risk of contracting a particular disease. Nurses can also use their knowledge and expertise to improve the efficiency of existing policies and propose future policies (Lee et al., 2018). Tobacco tax is an example of state healthcare policies. Tobacco smoking increases the risk of lung cancer and chronic obstructive pulmonary disease (COPD). Upward adjustment of tobacco taxes aims to discourage the use of the product, hence improving health and wellbeing of the community. This discussion reviews the tobacco tax policy.

Tobacco taxes are considered among the most effective policies in discouraging the use of tobacco use especially among younger people (world Health Organization, 2021). Increasing the taxes increases the prices of the products, hence making them expensive. As such, it reduces the number of habitual smokers. The policy also helps to increase revenues for the government. The funds are used to finance other tobacco policies, such as community education. Each state of the United States determines the amount to tax to impose on tobacco products depending on its unique goals and objectives. The most effective criteria for measuring the effectiveness of the policy is determining the decrease in tobacco use after the implementation of the policy. A significant decline implies that the policy was highly successful. No change, on the contrary, implies that the policy was not successful, thus requiring some modifications.

Social determinants such as the impact of the policies on employment affect the policy. The Tobacco industry is a multibillion industry that provides employment for millions of Americans. A drop in revenues caused by the impacts of the tobacco taxes results in loss of employment (Sheikh et al., 2021). However, there is a need to balance between the economic and health benefits of the product. If it costs the country much more to treat tobacco related illnesses than the economic benefits of the product, it is justifiable to impose much higher taxes to discourage the cultivation and consumption of tobacco.

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References

Lee, H.-F., Chiang, H.-Y., & Kuo, H.-T. (2018). Relationship between authentic leadership and nurses’ intent to leave: The mediating role of work environment and Burnout. Journal of Nursing Management, 27(1), 52–65. https://doi.org/10.1111/jonm.12648

Sheikh, Z. D., Branston, J. R., & Gilmore, A. B. (2021). Tobacco industry pricing strategies in response to Excise Tax Policies: A systematic review. Tobacco Control, 1–12. https://doi.org/10.1136/tobaccocontrol-2021-056630

World Health Organization. (2021). WHO technical manual on tobacco tax policy and administration. Geneva: World Health Organization.

Nurses and APRNs can actively participate in policy review in different ways. A nurse’s influence on policy evaluation protects patient safety, increases the quality of care, and gives access to resources (Arabi et. al, 2014). There are many steps that a nurse and APRN need to take to be involved in the policy review stage. This includes finding a concept of analysis and determining its purpose, reviewing the literature, and understanding the concept of influence (Arabi et. al, 2014). Another opportunity for a nurse and APRN to partake in policy review would be by advocating for their patients and becoming educated by joining organizations that help evaluate policies. These organizations like the Nursing Community Coalition, American Nurses Association’s Organizational Affiliates, and more can help nurses get their voices heard when advocating for their patients (AACN, n.d.).

The following are some of the difficulties that nurses and APRNs face when attempting to participate in policy evaluation. Nurses feel excluded and that their numbers are insufficient to be heard (Shariff, 2014). Nurses and APRNs frequently perceive a lack of policy and political development skills, a lack of policymaking education, and a lack of organizational support (Shariff, 2014). I would advise nurses to continue advocating for their patients and to educate themselves on policymaking. I would recommend joining an organization where a nurse’s voice is heard and discussing and reviewing the policy advocacy process, as the nurse is the backbone of patient advocacy (Jurns, 2019). Nurses and APRNs can continue to educate themselves and advocate for what they believe in, giving them a voice in policy evaluation and review.

References

American Association of Critical Care Nurses (AACN). (n.d.). Policy and advocacy. Received

from https://www.aacn.org/policy-and-advocacy

Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S. (2014). Nurses’ policy influence: A

concept analysis. Iranian journal of nursing and midwifery research, 19(3), 315–322.

Jurns, C. (2019). Policy advocacy motivators and barriers: Research results and applications.

OJIN: The Online Journal of Issues in Nursing Vol. 24, No. 3.

Shariff N. (2014). Factors that act as facilitators and barriers to nurse leaders’ participation in

health policy development. BMC nursing, 13, 20. https://doi.org/10.1186/1472-6955-13-20

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RE: Discussion – Week 9

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Nurses are at the forefront of reviewing health policies that policymakers have developed and put into law. Nurses are more equipped with the knowledge to help drive policymaking to be functional, sustainable, and successful due to the care they provide they can see how policy works for patients. Evaluating nursing policies is invaluable to the sustainability and success of the program. The importance of policy review helps congress and the executive branch to know what impact the program is having and is it achieving the goals that it was designed to do (Laureate Education, 2018). Being able to measure the outcome through effectiveness and efficiency is key to see if the program is successful (Laureate Education, 2018).

One strategy for nurses to engage in health and nursing policy review is through accessing a nation professional nursing organization-often through the first point of entry- the organization’s website (Catallo et al, 2014). Nurses have also joined forces with other professional organizations to create a movement that allows them to express their knowledge and feed it to policy makers through internships and working with the very people that develop health care policy. The American Nurses Association (ANA) has an entire section dedicated to advocating for health care policy making and review. One of ANA’s primary ways to achieve improved health care reform is by advocating on behalf of registered nurses at the top levels of the government as policies are conceived, debated, and implemented (ANA, n.d.). ANA is also responsible for monitoring federal agencies as they issue regulations and implementation of federal laws (ANA, n.d.).

Health care and public health systems around the world operate within frameworks of health policies. These health policies vitally and directly affect the delivery and availability of care for populations, health outcomes, health disparities, health equity, and the environmental, socio-cultural and industrial contexts of health workers (Turale & Kunaviktikul, 2019). Nurses can no longer afford to be blind to health care reform and policymaking. For so long nurses were content with doing their job and not becoming an active participant in health care policy design, implementation, and review and to prosper for the greater good nurses can no longer stay quiet.

While nurses are key in policy review, they have also encountered many barriers along the way. Barriers to nursing involvement in health policy have included a lack of political awareness and understanding of the importance of being involved in nursing organizations, time to engage in policy development outside of nursing work, and resources to develop skills in policy participation (Catallo et al, 2014). Nurses are the largest group of health care providers but in some countries they are not encouraged to engage in health policy, participation and reform, thankfully the United States encourages nurses to get involved through their profession nursing organization. Another challenge nurses encounter are bureaucratic walls which act as barriers to nurses being denied opportunities to openly voice their policy concerns (Turale & Kunaviktikul, 2019). Education is key to getting nurses to have the knowledge and comprehension to become actively involved in policy review. According to Turale and Kunaviktikul (2019) at the heart of nurses not being involved enough in policy, politics and advocacy is the gap in their education about these important matters. Nurses need access to well-thought-out policy training programs to effectively advocate for policy review and reform.

Nurses and APRNs can overcome these barriers by taking additional educational courses on policy making and review and getting involved. Nurses will never know how to impact change if they are not willing to learn. Education courses on health policy and politics is such as this one is a great way to get a foundation to improve knowledge and be able to actively participate in policy review and reform. Becoming an advanced educated nurse such as a APRN in education or leadership are great ways to strengthen knowledge and speak in a clear and professional means when advocating policymaking. When nurse leaders do not make it into the settings where decisions are made that have profound effects on health and health care-for example in parliament, in government, and in boardrooms of major organizations- they are often neither heard nor headed (Salvage & White, 2019). Nurses can impact change in policy review and reform if they get involved. Become a member of your local, state, and federal professional nursing organization. They offer support and offer toolkits to members on how to advance nursing and advocate for positive and effective change.

Resources

American Nurses Association. (n.d.). Practice and Advocacy. Retrieved from Federal Issues | Advocacy | American Nurses Association (nursingworld.org)

Catallo, C., Spalding. K., & Haghiri-Vijeh, R. (2014). Nursing Professional Organizations: What Are They Doing to Engage Nurses in Health Policy? Sage journals. https://doi.org/10.1177%2F2158244014560534

Laureate Education. (Producer). (2018). The Importance of Program Evaluation [Video file]. Baltimore, MD: Author

Salvage, J., & White, J. (2019). Nursing leadership and health policy: everybody’s business. International Nursing Review. https://doi.org/10.1111/inr.12523

Turale, S., & Kunaviktikul, W. (2019). The contribution of nurses to health policy and advocacy requires leaders to provide training and mentorship. International Nursing Review. https://doi.org/10.1111/inr.12550

RE: Discussion – Week 9

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Just like in policy development, RN’s and APRN’s have the opportunity to participate in policy review. When programs and policies are implemented it is not a given that they will be effective, will work out as intended, or not have unforeseen impact (Laureate Education, 2018). Policy review is just as important, if not more so, than policy development. The evaluation component is something that needs to be considered from the beginning because it is important to see if a bill needs to be reshaped and written in a way to reach the legislators or public in a better way (Laureate Education, 2018).

APRN’s have a direct line into program evaluation in their line of work. Programs funded by governments, nonprofit organizations, and most private foundations require that these programs be evaluated regularly to meet a variety of criteria, including ensuring that the program is being conducted as developed, that there is fiscal responsibility, that goals and objectives are being met, and increasingly, that the outcomes are examined (Milstead & Short, 2019). Most APRN’s are directly involved in these types of programs. Especially in small, community-based programs, an APRN could be selected to study the needs of different social groups, plan program interventions, help to write proposals, as well as work to develop the evaluation process (Milstead & Short, 2019). This is one example of how a professional nurse can actively participate in policy review.

Another way a professional nurse can directly participate in policy review would be for the RN or APRN to develop a relationship with local legislators who are the ones supporting whatever legislation you are trying to get passed. You can be the one to provide the evaluation data to them to demonstrate that the program you are suggesting is or will work. They can then provide you with questions or feedback of things that need to be revised in the program, and you can take that information back to recraft the program if needed (Laureate Education, 2018).

Nurses policy influence is the nurse’s ability in influencing decisions and affairs related to health through political knowledge, effective communication, and collaboration with other members of the health team, which results in the improvement of nurse’s job environment and increases patient outcomes (Arabi, Rafii, Cheraghi, & Ghiyasvandian, 2014). We can see the importance of nurse’s influence of policy development and evaluation, but there are struggles to accomplish these tasks. If an APRN works in a place where government funded program design isn’t happening, it may be hard for them to become involved in policy review and evaluation. They may have to look at how their policies are developed and figure out how they can use where they are at to become an active participant in this area. Another foreseen barrier would be the struggle to develop relationships with legislators. This may take many years. You may have to work your way up the ladder by researching their view on topics, who works beneath them and start to develop those relationships lower down the ladder until you can work your way up.

Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S. (2014, May). Nurses’ policy

influence: A concept analysis. Retrieved April 20, 2020, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061635/

Laureate Education (Producer). (2018). Program Policy and Evaluation[Video file]. Baltimore,

MD: Author.

Laureate Education (Producer). (2018). The Importance of Program Evaluation [Video file].

Baltimore, MD: Author.

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

Burlington, MA: Jones & Bartlett Learning.

Hi K..,

I enjoyed reading your post. You listed some great ideas on how nurses can get involved in policy evaluation. Here are a few suggestions to consider as well. Many nurses think they must get involved in a major nursing association or contact their congress members to be involved in this evaluation step of health policy. However, we are involved daily with evaluation. The patient evaluation we document daily is compiled to be used in reports that are forwarded on to people who use this information at the state and federal levels to make policy changes and improvements. This information becomes evidence-based to justify or improve efficiency (Laureate Education (Producer), 2018). As nurses, we must be mindful of this every time we chart patient outcomes. Everyone involved in the policy procedure of design, implementation, and evaluation can view documentation provided by nurses to see the effect their policies and programs have and whether they are efficient and productive or not (Milstead, J. A., & Short, N. M.,2019). It takes all of us to design, implement, and evaluate health policies and programs for the best patient outcomes possible.

References

Laureate Education (Producer). (2018). The Importance of Program Evaluation [Video file]. Baltimore, MD: Author.

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

Response 2

Week 9

Kayla, I enjoyed reading your post as you made good points regarding policy review. In one of your challenges you posted you said that it may be hard to develop a relationship with legislators. I have also wandered how a nurse or anyone for that matter can start to develop a relationship with a legislator to be able to get there voice out there. I feel that without having a means of a relationship will greatly increase the difficulty of trying to participate in political matters. I am sure that representatives are also overwhelmed at times by lobbyist, and without proper planning, time, and research in whatever you are trying to change your actions may just be thrown to the side. This is why I feel it necessary to develop relationships and spend time with your local representatives and lobbyist. An introduction from the American College of Clinical Pharmacy states “An effective and sustained relationship with a Member of Congress and staff members in the Congressional office is built upon a foundation of personal communications and face-to-face exchanges. These must occur consistently over time so that the other communications that you will invariably need to use – letters, e-mails, phone calls, — will have the kind of personal impact and value that can result in real action from the office in support of the issues of importance to you” (Webb, E. n.d.).

There are also some ways you can start building these relationships. These tips I found from the American Academy of Ambulatory Care Nursing seem to be a good starting point for nurses to take to get to the initial development of knowing and having your representatives know you. “face-to-face meetings, telephone calls, letters, or e-mails. Generally, the more personal the contact, the more effective. If you cannot meet with a legislator, a meeting with his/her legislative assistant is almost as good” (Phillips. R. 2003). Generally, this is what lobbyist do. So, you can technically call yourself a nursing lobbyist by performing these tasks.

References

Phillips, R. (2003). The ABC’s of Lobbying. American Academy of Ambulatory Care Nursing.

Retrieved from: https://www.aaacn.org/volunteer/teams/legislative/abcs-lobbying

Webb, E. (n.d.). Building Relationships with Elected Officials. American College of Clinical

Pharmacy. Retrieved from: https://www.accp.com/docs/govt/advocacy/ga_build.pdf

RE: Discussion – Week 9

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Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S. (2014, May). Nurses’ policy

influence: A concept analysis. Retrieved April 20, 2020, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061635/

Laureate Education (Producer). (2018). Program Policy and Evaluation[Video file]. Baltimore,

MD: Author.

Laureate Education (Producer). (2018). The Importance of Program Evaluation [Video file].

Baltimore, MD: Author.

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

Burlington, MA: Jones & Bartlett Learning.

RE: Discussion – Week 9 Initial Post

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Promoting Evaluation

Nurses’ influence on health policy remains a newer concept in nursing. There are many opportunities for nurses to become involved in policymaking and policy enhancement. S.1602 was established to increase the availability of school nurses in school districts, that 20% of students were granted reduced or free lunches. There were many supporting findings, such as in 2017, the National Association of School Nurses reported 39.3% of schools employed a full-time school nurse (Davidson, 2014). Furthermore, national data indicates that between 15-20% of school children have a chronic health condition. Since S.1602 has been introduced, if passed, it will be imperative to evaluate its success in measurable units.

Many times, nurses also have difficulty evaluating evidence-based health care policy. In this particular S.1602- Nurse Act Bill, nurses have the opportunity to show effectiveness by evidence. The success can be measured by the increase of nurses hired and the enhanced health of the students. Items that should be computed are students’ attendance, classroom time, academic achievement, and health (Congress, 2021). APRNS and nurses can assist with this by being active participants. Practice change occurs when there is an active engagement of nurse leaders (Davidson, 2014). Active engagement is challenging because there is limited time and resources for APRNs to research and practice. A way to increase participation is funding, and S.1602 has allotted a sufficient amount to hire nurses to practice. One additional step would be to fund nurses to gather the data and research the items that should be computed.

Although nurses form the most significant profession of the United States’ healthcare workforce, we lack involvement in health care making and enhancement. Every day is an opportunity to become involved. Search topics that are important to you and take your stance as a health care leader to ignite the implementation and evaluation of policies for the wellness of our communities.

References:

Congress. (2021). S.1602 Nurse Act. 117^th Congress. https://www.congress.gov/bill/117th-congress/senate-bill/1602/text?q=%7B%22search%22%3A%5B%22nurse%22%2C%22nurse%22%5D%7D&r=2&s=1

Davidson, J. (January 1, 2014). Evaluation of nurse engagement in evidence-based practice. AACN Advanced Critical Care, 25(1):43-55. https://doi.org/10.4037/NCI.0000000000000006

Glasgow, R.E., Lichtenstein, E. & Marcus, A.C. (2003). Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. American Journal of Public Health, 93(8), 1261-1267. https://eds-p-ebscohost-com.ezp.waldenulibrary.org/eds/detail/detail?vid=0&sid=034020d0-0a73-4bfa-b6f1-ab78c877d060%40redis&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=10595993&db=bth

The Role of the RN/APRN in Policy Evaluation

Notably, RNs and APRNs have the capacity and the responsibility of influencing the future of healthcare delivery systems. Both RNs and APRNs operate in a framework that holistically values people and creates the need to include them as participants in the policy review. RNs and APRNs are to influence the processes and practice standards that assure the quality of care. For instance, nurses influence a policy that shapes the care effectively in providing care today and in the future (Turale & Kunaviktikul, 2019). The first opportunity for RNs and APRNs to actively participate in a policy review is for nurses to volunteer their time if they are part of members. Secondly, they can run for an office position and internship with the elected officials at a federal, state, or local level.

The challenges that the opportunity may present include a lack of involvement, knowledge, and skill relating to the policy review. Notably, lack of opportunity such as input upon an Adhoc at the various levels includes the lack of experience and poor planning on the process of problem identification (Shariff, 2014). Additionally, the lack of poor enough resources enables the structure to enhance easy participation in the policy review. The lack of enabling structure is considered a barrier in that limited nurse participation in health policy can lead to inadequate representation of nurse leaders.

The two strategies that can help communicate and ensure existence include implementing effective communication that would aid in enhancing knowledge and skill that relates to the policy review. Additionally, implementing good leadership would help ensure effective communication; they will play a role in addressing the issue of lack of opportunity and managing an effective plan that will make the process successful (Hudson et al., 2019). For instance, good leadership will ensure that the RNs and APRNs are experienced in helping the policy review a success.

References

Hudson, B., Hunter, D., & Peckham, S. (2019). Policy failure and the policy-implementation gap: can policy support programs help? Policy Design and Practice, 2(1), 1-14. https://www.tandfonline.com/doi/abs/10.1080/25741292.2018.1540378

Shariff, N. (2014). Factors that act as facilitators and barriers to nurse leaders’ participation in health policy development. BMC Nursing, 13(1), 1-13. https://link.springer.com/article/10.1186/1472-6955-13-20

Nurses are the backbones of the medical system. The nursing profession is the largest in the U.S. healthcare industry. For seventeen consecutive years, nursing ranked the most trusted job in Gallop’s ethic survey (For the 17th Year in a Row, Nurses Top Gallup’s Poll of Most Trusted Profession | AHA News, 2019). With so many responsibilities in nursing, it is an obligation that nurses actively participate in the policy review. By involving in policy review, nurses draft and analyze policies to be in a better position to advocate for their patients. This post will discuss the opportunities that currently exist for RNs and APRNs to actively participate in policymaking.

One opportunity for RNs and APRNs to actively participate in policymaking is policy draft. Through policy drafts, nurses will be able to identify topics that will be critical for the next few years in healthcare. For example, Covid-19 pandemic really took a toll in U.S. healthcare industry. As of date, over 700,000 people have died from Covid-19 infection in America (CDC, 2020). Nurses played a significant role in the fight against Covid-19 and continue in the path to defeat this deadly virus. Professional experiences of the nurses who worked with Covid-19 infected patients speak volumes about how exhausted the healthcare system is. During the rollout of the Covid-19 vaccines, professional nurses were argued to engage in the vaccine advocacy campaign. Advocacy is a skill that nurses often use in their career; therefore, pairing that skill with a policy draft will enable nurses to organize the policy document with operational benefits properly. A well-drafted document will be easier to administer, maintain and enforce. Likewise, Rasheed et al. (2020, P 447, Para 2) stress the importance that “due to their close interactions with individuals and communities across the healthcare system, nurses can offer greater direct insights concerning the effect of healthcare policies on individuals and communities.” So, nurses need to be the drafters of the policies because it will reduce the overall amount of time an organization needs to spend on those activities, for example, vaccine advocacy programs. Appropriate content and specific knowledge and skills are essential in the policy document to avoid valuable time being wasted editing, discussing, and rewording statements that do not belong in the policy in the first place.

After completing a well-drafted policy document, nurses can participate in policy analysis and evaluate the current policy. They can make a judgment about what went well and what did not, “whom to involve in future efforts, whom to trust, what the most effective timing is, how to create more powerful coalitions, and so forth” (Yoder‐Wise, 2019, p 52). The evaluation step is crucial because it allows the group to determine how to protect the current success and strategies needed to succeed. However, there are challenges to these opportunities.

Policy drafting and analysis opportunities may present challenges because of poor technical knowledge and clinical skills and a lack of exposure to federal and state government involvement (Scott and Scott, 2020). These current opportunities present challenges that can be overcome by proper training regarding policy draft and analysis during undergraduate nursing level and, of course, at the graduate level, encouraging students and faculty to participate in politics for policymaking and visiting the state and federal policy places. Scott and Scott (2020) argue that establishing relationships with policymakers is one of the best methods to get your issue on their agenda; it is about who you know and how you can influence them to listen to you. Therefore, nurses must visit their local representatives to understand their stand on specific issues. For example, if the nurse advocates for Covid-19 vaccines, they need to know how their local representative feels about the mass vaccination because if the representative does not fully support the vaccines, then the nurses will lose the support for publicizing the importance of the vaccines. The representative can lobby against it because it is not profitable for them, challenging the nurses to prove their support and decisions. If that becomes the case, nurses can use irrefutable evidence and knowledge more clearly and justifiably to publicize their support for the policy.

The strategies for better advocating are training and education programs for the nurses. Nurses already understand that they are the largest number of healthcare professionals in the healthcare industry, and therefore, their voices and suggestions are essential. Advocating for patients at the bedside is as important as advocating for them at the state or federal government. Nurses must understand that what they want for their patients, only they can deliver, and so, therefore, no one else can provide that on their behalf (Scott and Scott 2020). Suggestions from nurses will ensure safe and quality care through policymaking.

References

CDC. (2020, March 28). COVID Data Tracker. Centers for Disease Control and Prevention. https://covid.cdc.gov/covid-data-tracker/#datatracker-home

For the 17th year in a row, nurses top Gallup’s poll of most trusted profession | AHA News. (2019, January 9). American Hospital Association | AHA News. https://www.aha.org/news/insights-and-analysis/2019-01-09-17th-year-row-nurses-top-gallups-poll-most-trusted-profession

Rasheed, S. P., Younas, A., & Mehdi, F. (2020). Challenges, Extent of Involvement, and the Impact of Nurses’ Involvement in Politics and Policy Making in in Last Two Decades: An Integrative Review. Journal of Nursing Scholarship, 52(4), 446–455. https://doi.org/10.1111/jnu.12567

Scott, S. M., & Scott, P. A. (2020). Nursing, advocacy and public policy. Nursing Ethics, 28(5), 723–733. https://doi.org/10.1177/0969733020961823

Yoder‐Wise, P. S. (2019). A framework for planned policy change. Nursing Forum, 55(1), 45–53. https://doi.org/10.1111/nuf.12381

Tax-payer dollars are a conundrum of sorts but not to mention always a hot topic of debates at the capital, city halls, and local towns. After all, the publics’ voting is reflective of what each candidate will be doing with taxpayers’ dollars. Program and policy in nursing are no different. For example, money, in the form of tax-payer dollars, is being requested to be allocated to either reshape, support a bill, or research and not personal monies Laureate Education (2018b). A great majority of decisions and programs at the federal, state, and local levels, involve the health status of the population Milstead and Short (2019). One must be engaged in continuous evaluation at every level of program planning related to the economic impact as tax-payer dollars Milstead and Short (2019). Nurses impact policy through evaluation are poised to measure what the impact is likely to be and the effectiveness of the implemented program, outcomes, or policy Laureate Education (2018b). Furthermore, nurses can review current policy, like at their place of employment or within their practicing state, and engage in evaluation to see why a process did not work Milstead and Short (2019). According to Milstead and Short (2019), nurses must be in the hierarchy of those in attendance having a pivotal voice at meetings for the redesign of healthcare systems. This includes being engaged from the beginning of policy planning with key participants, to program evaluation of healthcare policies within facilities Milstead and Short (2019). Also, the bill could also come from congress that a nurse may evaluate Laureate Education (2018b). Nurses should utilize the “five-step” framework from the Center for Disease Control and Prevention (CDC) for the evaluation in public health CDC (n.d.). Nurses must promote cost clarity, patient education, and assist with the dispersion of accurate evaluation results Milstead and Short (2019). Leadership roles, like that of nurses, at times are met with adversity.

Challenges

There can be several challenges during program planning more so if the program is not completed in a tried format. This can be burdensome on program planning; however, most can be alleviated. Some of these challenges are out of the hands of the researcher and others are more apparent. For example, at times, the new policy may go through congress quickly or too slow with the respective audience, either the branch of government or the public, requesting the evaluation results quicker than anticipated Milstead and Short (2019). Also, when comparing the context of other policies, deficiency of suitable data results may exhibit making it difficult to determine the effect Milstead and Short (2019). Some evaluation results can be unexpected and can divide communities creating a new focus regarding social or health policies Milstead and Short (2019). Take COVID-19 for example, where some regions were being hit much harder than others and that required refocus and replanning for the safety of everyone. Limited resources or not having the appropriate person to complete the evaluation could also jeopardize program evaluations Milstead and Short (2019). According to Laureate Education (2018b), while measuring the efficiency or effectiveness of a program that did not yield expected results can result in inaccurate results. Fortunately, there are available steps nursing and other vital personal can integrate to decrease or alleviate the above-listed challenges.

How to Overcome Challenges

For program planning, one can be proactive to prevent problems that occur during the program evaluation from a nursing standpoint. Assigning a “point person” to the program is instrumental for the success of a program for they are a professional analyst who is accountable for compiling and creating the evaluation (Milstead & Short, 2019, p. 122). Other strategies available to nurses to guide effective evaluation and overcome challenges include the following. Implementing and applying a series of predetermined questions to the research program will address some challenges before they occur Agency for Healthcare Research and Quality (AHRQ, 2021). For example, is the bill or program doing what it is intended to do? How was the data collected and analyzed? Was the data reviewed by a trustworthy research team? Is it unbiased and complete Laureate Education (2018b)? Furthermore, AHRQ (2021) has compiled several questions to answer during the development of the plan. Some of these include “Who needs to act on the results and who will make decisions based on the results?” (AHRQ, 2021). Ethical issues need to be addressed and governed during the program building to ensure reliability and effectiveness.

Laureate Education (2018a) discusses ethics and advocacy and a point addressed is when a program is implemented, the creation of another implication can be created to address the ethics component of it. For example, it could have been argued that when the needle exchange program went into effect that there would be more drug users. Instead, to address the ethics component, this program had a triple purpose with two ultimately addressing the risk of increased drug users. These included addressing the overdose with drug treatment options, needle exchange, and training addicts to revive those that have overdoses Laureate Education (2018a). In addition, available to nurses is the “Five-step framework” to guide policies and programs with guidelines regarding public health actions (Centers for Disease Control and Prevention, n.d.).

Strategies to Advocate or Communicate the Existence of these Opportunities

To any plan, or project created or altered, strategies are available to communicate the existence of the prior discussed opportunities. To address ethical issues, there is professional organizations that provide ethical guidelines for evaluation CDC (n.d.). For example, American Counseling Association, the American Psychological Association, and other professional organizations have available a series of ethical principles questions and principles that nurses should utilize while implementing and creating their planning Milstead and Short (2019). Milstead and Short (2019) have a list of strategies that can be used during the project planning that are directly related to communication approaches. These include using the most suitable methods during the evaluation, such as the CDC framework for program evaluation. Also, to identify key participants and multiple other vital members with the overall aim, and address conflicts rapidly. Lastly, habitually connecting with members throughout the execution and evaluation cycle of the project is critical Milstead and Short (2019). These strategies when combined with other beneficial theories and guidelines can have a positive effect on the entire process of project planning from beginning to end Milstead and Short (2019).

References

Agency for Healthcare Research and Quality. (2021). Elements of an Evaluation Plan. Retrieved from ahrq.gov

Centers for Disease Control and Prevention. (n.d.). Program Performance and Evaluation Office (PPEO). Retrieved from cdc.gov

Laureate Education (Producer). (2018a). Peter Beilenson: Ethics and advocacy [Video file]. Baltimore, MD: Author.

Laureate Education (Producer). (2018b). The Importance of Program Evaluation [Video file]. Baltimore, MD: Author.

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

Good post! There is a strong correlation between food security and chronic health conditions among various age groups, including children, working-age adults, and seniors. According to the Center on Budget and Policy Priorities (2018), people in food-insecure households – those lacking consistent access to adequate food at some point during the year due to limited resources – spend roughly 45% more on medical care in a year ($6,100) than people in food-secure households ($4,200) (para 4), and that is why SNAP was created by the U.S. Department of Agriculture (USDA). The effectiveness of SNAP in combating poverty and hunger is evaluated through various measures and surveys. According to a national survey conducted by the USDA, SNAP served an average of approximately 42 million American people per month in the 2023 fiscal year (USDAb, 2023), with the U.S. having a population of approximately 331 million people. The National Household Food Acquisition and Purchase Survey (FoodAPS) is another national survey conducted by the USDA that collects data from SNAP households, low-income households not participating in SNAP, and higher-income households. This survey entails asking individuals where they acquire their food, how much they pay, how/if they use food assistance programs, and the factors that influence their food choices (USDAa, 2023). The data collected from FoodAPS is used to understand household food behaviors better and can inform the development and evaluation of food and nutrition policies and interventions. SNAP’s effectiveness can be constrained by factors such as the adequacy of benefit amounts, accessibility issues, and the stigma associated with receiving assistance.

Nurses, with their firsthand experience in patient care and their understanding of health determinants, can play a significant role in policymaking, including policies related to food security and poverty. They can advocate for policies that address social determinants of health, including food insecurity, and can use their experiences to inform policymakers about the real-world impacts of these issues. They can provide testimony about the health impacts of food insecurity they observe in their patients, advocate for seeking welfare assistance for healthy foods, or they can participate in research studies that generate data on these issues and evaluate outcomes. Nurses can also serve on advisory committees or professional nursing organizations, or they can engage in direct lobbying efforts.

Thanks for your post!

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Name: NURS_6003_Module01_Week01_Discussion_Rubric

	Excellent	Good	Fair	Poor
Main Posting	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.	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. 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.	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.	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	10 (10%) – 10 (10%) Posts main post by day 3.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%) Does not post by day 3.
First Response	17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	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.	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.	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	16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	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.	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.	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	5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%) Does not meet requirements for participation by posting on 3 different days.

Total Points: 100

I chose the Affordable Health Care Act Policy as this is well-known and has been a big part of the legislation. The Affordable Care Act (ACA) makes affordable health insurance available to more people. The law provides consumers with subsidies and tax credits that lower costs for households with incomes between 100% and 400% of the federal poverty level (Affordable Care Act, 2020). Politics plays heavily into policy making and evaluation. A video from Walden University (2018) featuring Joel Teitelbaum shares, “It is clear that politics is playing a vital role in the design of the outset and now the implementation and evaluation of the ACA.” A program could not be successful after many years if it were not being evaluated and adjusted.

There have been several ways the ACA has been evaluated over time. After evaluation, the ACA has changed from 2011-2022. The policy will always change as the population grows, presidents change, and the cost rises or falls over time. One of the first ways the policy has been evaluated is by the number of individuals enrolled from 2010 to 2022. The government calls this administrative data and has looked at how many people have enrolled through new health insurance marketplaces or the number of people who have enrolled in Medicaid. As numbers have increased over time, policymakers have assumed success. So, if fewer Americans lack health insurance, it will be a crucial indicator of how well the ACA is working.

Administrative data can be limited, so A lot of the policies evaluation has come from surveys over time. In 2014 before federal surveys were allowed, they launched, the Health Reform Survey, this is a quarterly survey of the nonelderly designed to provide timely information on implementation issues under the Affordable Care Act (ACA) and changes in health insurance coverage and related health outcomes (Long,2014). This looked at data, affordability, participation, and healthcare access. It helped give a good visual of implementation success. After that rolled out so did other surveys that had been given to private entities, which ask about health insurance by type of coverage and track changes over time. Another survey that is often a source of health coverage evaluation is the Annual Social and Economic Supplement (ASEC) to the Current Population Survey, which provides socioeconomic and demographic information, including health coverage status, for the non-institutionalized U.S. population (Montero,2022). The surveys look at insurance utilization and insurance status. The survey data received from the U.S. Department of Human Services and Medicare has been used for the evaluation and success of the policy.

Social determinants weigh heavily in the health world, especially regarding the ACA. The World Health Organization defines social determinants of health as the conditions in which people are born, grow, live, work, and age (Abrams,2017). Racism, poverty, unsafe neighborhoods, and lack of education are some of the many social determinants that create health inequity in our country (Leong & Roberts,2013). Not everyone had access to healthcare in 2010 due to the high costs of plans. Poverty greatly affected this over time as money was required to deliver efficient care safely. The Affordable Care Act expansion did lessen the consequences of socioeconomic status and healthcare access by assisting disadvantaged persons in receiving health services. The ACA has been a tremendous help to those falling at or under the poverty level.

References

Abrams, M. (2017). Chapter 7 – Social Determinants of Health. Alliance for Health Policy. Retrieved October 19, 2022, from https://www.allhealthpolicy.org/sourcebook/social-determinants-of-health/

Centers for Medicare & Medicaid Services. (2020). Affordable Care Act (ACA). Federal Poverty Level (FPL) – Glossary | HealthCare.gov. Retrieved October 19, 2022, from https://www.healthcare.gov/glossary/federal-poverty-level-fpl/

Leong, D., & Roberts, E. (2013). Social determinants of health and the Affordable Care

Act. Rhode Island medical journal (2013), 96(7), 20–22.

Long , S. (2014). What do we know about ACA implementation? introducing the Health Reform Monitoring Survey. Introducing the Health Reform Monitoring Survey. Retrieved October 20, 2022, from https://www.urban.org/urban-wire/what-do-we-know-about-aca-implementation-introducing-health-reform-monitoring-survey

Montero,A. (2022). Measuring Changes in Insurance Coverage Under the Affordable Care Act.

KFF. Retrieved October 19, 2022, from https://www.kff.org/health-reform/poll-finding/5-charts-about-public-opinion-on-the-affordable-care-act-and-the-supreme-court/

Walden University, LLC. (Producer). (2018). Introduction to Health Policy and Law with Joel

Teitelbaum [Video file]. Baltimore, MD: Author.

I like your choice of program for this discussion. The ACA has undergone quite a bit of change as it has changed hands throughout different presidencies. I agree that it has had many positive impacts on people below the poverty line and has led to many becoming insured that could previously not afford to be. I believe that evaluating this program in future years is key as the times change. What was the solution when the program was signed into law may not be the solution in future years. As the program changes hands and different presidents and congress staff changes, hopefully beneficial changes are made to allow this to continue to be a beneficial program. I do not think there is a perfect solution to healthcare, however those in charge must strive to continue to evaluate and amend this program.

-Joe

References

Centers for Medicare & Medicaid Services. (2020). Affordable Care Act (ACA). Federal Poverty Level (FPL) – Glossary | HealthCare.gov. Retrieved October 27, 2022, from https://www.healthcare.gov/glossary/federal-poverty-level-fpl/

Effect of the Affordable Care Act in Maryland. (n.d.). ballotpedia.org/ Retrieved on 10/27/2022 from https://ballotpedia.org/Effect_of_the_Affordable_Care_Act_in_Maryland_(2009- 2017)

Discussion: The Role of the RN/APRN in Policy Evaluation NURS 6050