NR 447 Week 1 Discussion The Affordable Care Act Recent

NR 447 Week 1 Discussion The Affordable Care Act Recent

NR 447 Week 1 Discussion The Affordable Care Act Recent

The Affordable Care Act

Healthcare reform is a term that is ever present in our practice settings and will not disappear any time soon.
Share with the class implementation of the Affordable Care Act in your organization. (If you are not working as a nurse, think about what was happening when you were a prelicensure student)
How did your fellow healthcare workers react to implementation of the ACA?
How were citizens in your community impacted?

Health care costs have surged over time, and different populations are affected differently depending on income levels, family size, and locations, among other factors. Regardless of a person’s characteristics, a safety net is necessary when one gets sick. Health insurance coverage is the most reliable safety net. Due to economic challenges, it is crucial to support more people to afford health insurance through subsidies.

The Affordable Care Act (ACA) has several subsidies. According to Keith (2021), qualifying for a subsidy depends on a person’s income level compared to the federal poverty level, family size, and the amount a person spends on health insurance. Among these factors, income is the main consideration. A person qualifies for an ACA subsidy if they make u to four times the Federal Poverty Level (IRS, 2021). When it comes to spending on health insurance, a person qualifies for a subsidy if the spending is more than 8.5% of the household income (Cox et al., 2021). In each case, the goal is to promote access to health insurance coverage, which has been a significant barrier towards equitable and accessible

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Qualifications for ACA and its subsidies differ from Medicaid to a considerable extent. The process, costs, and target group for each differ. As Pollitz et al. (2019) explained, the primary difference between ACA and Medicaid is that ACA plans are provided by private health insurance companies while Medicaid and its related support is government-administered. As a result, Medicare costs people lesser than ACA. On target groups, Medicare focuses on people from 65 years and above. Some people may qualify through disability, which is not the case with ACA. Despite the differences, the plans have been instrumental in reducing the illness burden by facilitating access to care.

NR 447 Week 1 Discussion The Affordable Care Act Recent References

Cox, C., Amin, K., Claxton, G., & McDermont. (2021). The ACA family glitch and affordability of employer coverage. KFF.

IRS. (2021). Eligibility for the premium tax credit.

Keith, K. (2021). Final coverage provisions in the American Rescue Plan and what comes next. Health Affairs, March11, 2021.

Pollitz, K., Neuman, T., Tolbert, J., Rudowitz, R., Cox, C., Claxton, G., & Levitt, L. (2019). What’s The Role of Private Health Insurance Today and Under Medicare-for-all and Other Public Option Proposals? KFF.

I have always been one of those people who constantly ask why. I feel that knowing why I do a skill or why I give a medication is important. More importantly, I hate not having a consistent and steadfast reason when a patient asks why I am doing a skill a certain way or giving a medication. After reading your post, I was inspired to research the case of Lorenza Somera. Somera was a new graduate nurse in Manila in the Philippines. The doctor ordered cocaine injections for a tonsillectomy patient. Somera followed those orders and subsequently, the patient died. The order should have been for procaine injections. The courts found the doctor not guilty and ruled that Somera should have questioned the physician’s order. The courts charged Somera with manslaughter. It is appalling that a new graduate nurse was charged with manslaughter for following a physician’s order. Nurses now are taught to question any orders that do not feel comfortable executing. In 1929, that was not the case. Nurses at that time were educated that allegiance to the doctor meant that the patient was better served. “The Somera case sparked worldwide protests from nurses and served to push nursing toward independent practice and accountability” (Mason, et. al., 2016, p. 31). 

After the Somera case, nurses began to continuously pursue new guidelines for practice. Autonomy and patient advocacy were the forefront for this protest. Even with this push for independence and patient advocacy, it wasn’t until 1978 that the ANA code of Ethics announced that “In the role of client advocate, the nurse must be alert to and take appropriate action regarding any instances of incompetent, unethical or illegal practice(s) by any member of the health care team or the health care system itself, or any action on the part of others that is prejudicial to the client’s best interest” (Mason, et. al., 2016, p. 32). 

The Somera case brought to light many issues regarding the patriarchal relationship between nurses and doctors. It is unfortunate that Somera was charged with manslaughter but, the circumstances surrounding Somera’s involvement brought about changes that were drastically needed in nursing. If this case would have never happened, where would we be now?  We would not be discussing evidence-based practice from a nursing standpoint. 

One of the most common ways that nurses utilize evidence-based practice is with patient safety. Per Titler, “Evidence-based practice (EBP) is the conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions” (Titler, 2008, p. 113). It is vital to involve the patient and his / her family in the plan of care for the best conceivable outcomes. The patient must be aware of all possible choices and options related to care before deciding which route to take. 

To choose the best possible evidence-based practice for my unit, I should do more research. I must read the articles because none seem to relate to an adult only ED except maybe hospital readmissions. I look forward to learning new information as I research the topics. 


Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (Eds). (2016). Policy & politics in nursing and healthcare (7th ed.). Retrieved from to an external site.CAAAQBAJ&pg=PA31&lpg =PA31&dq=1929+nurse+in+philippines+ charged +with+manslaughter &source=bl&ots=57JsKKMO-K&sig=qzyQExee8go9sy 0ZYA5rv_CICro&hl =en&sa=X&ved=0ah UKEwjiioaynfzVAhXK4CYKHcu9Dcw Q6AEILTAB#v =onepage&q=1929%20nurse%20in%20philippines%20charged%20with%20manslaughter&f=false 

Titler MG. The Evidence for Evidence-Based Practice Implementation. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 7.Available from: to an external site. 

Yes it is unfortunate that it took something like the tragedy of the Somera case to bring about change and it is something we as nurses should think about moving forward.  We should always be advocates for our patients and use the best EBP to care for our patients.  Which model do you think is the easiest and most appropriate for use in nursing practice?  It there a model that you or your organization uses already? 

I believe the Johns Hopkins Nursing Evidence-Based Practice Model is the easiest and most appropriate model. “The strength of the Johns Hopkins model is its reliance on a strong academic–clinical collaboration as a foundation for mutual benefit” (Houser, 2018, p. 470).This model only has three phases, but has multiple steps within each phase. Each step is clearly defined and gives exact instructions on how to move forward. For a novice in evidence-based practice, this model would give me all the checks and balances needed to ensure I wasn’t overlooking crucial information. I do not know which model my facility utilizes but I do know that the supporting frameworks used at my facility are patient-centered care and shared decision-making. 


Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Sudbury, MA: Jones & Bartlett. 

I also found that the “PET” tool designed and used by Johns Hopkins appeared to be more user friendly.  I also like the part where the research goes into actions and therefore we can develop a process or modify as it seen necessary. 

My present job I am a Quality Improvement Analyst and work with a team of non-clinical staff and developing processes is our business.  However, in a bedside clinical practice ACE: Evidence-Based Practice model would be a better tool to use.  I am grateful that there is more than enough models to chose from. 

When I was in nursing (which was not long ago) the professors asked the students the question why. Why are we doing it this? I remember being in clinical giving a medication and my clinical instructor sending me out because I did not have the correct diagnoses the patient was receiving the medication for. That has stuck with me. I am in wound care now, and started the job with no experience with 2 days of training! I have to look up the best researcher to prevent wounds and also how to take care of the wounds. Educating myself and the family to these new practices is very important. The best way to bring it to the beside is to practice what you have learned. 

How do you know what is the “best” practice?  How do you decipher from all the research?  Which research is considered most correct? 

I have always been taught that it depends on your patient or resident for the best practice. Individualize care is what it is about. What may work for one person may not work for the other. A good way to determine best research is the most current, and depending on the ending of the website such as org or edu. 

I would have to agree that individualized care or patient centered care is the way to go. I also believe that as healthcare has shifted to  this approach ,the input of patients and their families are vital in determining best practice.  As nurses we are to educate on options, support decision,and facilitate intervention for positive outcome. Thanks for this weeks’ insight. 

I have always wanted to know the “why” behind everything. I remember asking this question a lot as a child and getting the answer, “just because”. Unfortunately, I still hear this answer today in my nursing practice, along with “because this is how we’ve always done it”. Another response that I hear when a practice change is suggested is “why do we need to change?” or “there’s nothing wrong with the way we do it now.” People are always going to be resistant change because of fear of the unknown. If evidence-based practice (EBP) is implemented correctly, this can help decrease that fear and open people up to change. 

Evidence-based practice means utilizing the best clinical evidence to make sound patient-care decisions. By using EBP, nursing rituals and traditions can be examined and determine if they need to be replaced with practices founded by scientific research. To use EBP one must know how to obtain, interpret, and integrate it into nursing practice. I found six steps that can help make EBP a reality at the bedside. Step 1 is to identify a clinical practice problem in the unit or an idea from a research article. Step 2 is to create a team with varied clinical and research skills to evaluate the evidence. Step 3 is to develop a plan of action. Step 4 is to implement and promote the plan.

Staff education is vital in this step. Step 5 is to evaluate the results. Outcome measurements should be gather over 6 to 12 months to adequately evaluate the effectiveness of the new nursing intervention. Step 6 is to share the results. It is important to continually share the results with staff to maintain forward movement with the new intervention (Lawson, 2005). Following these steps will help to successfully implement EBP at the bedside and decrease resistance from staff that fear change. 

The best way to integrate patient and family into evidence-based practice is by involving them in the process. It is important, as I talked about in my original post, for the patient and family to be well informed about all options as to make informed decisions. 

The practice that I would decide to integrate into my practice is one that shows strong evidence for a practice change. It can’t just be based on popular opinion or on how things have always been done. Sound research that shows positive patients outcomes is needed to change practice. 


Lawson, P. (2005). Doing it better: putting research into practice. How to bring evidence-based practice to the bedside. Nursing, 35(3), 18-19. 

I really enjoyed reading your post. I have always heard the why, it’s something behind every why after research. A few years ago at a facility I worked at, had the staff look at a video who move my cheese,  because so many were resistant to change,  and it’s always good to change if it’s no longer working,  just like medications, in any growing industry a person must be willing to be flexible in order for growth, and a positive outcome   especially when dealing with patients and their families. 

Professor, when I went to nursing school 34 years ago, “Evidence based practice” in the same sentence was not heard of either.  However, Florence Nightingale was my roommate (lol if it is allowed).  I began to learn about research in the 80’s when bedside care and nurses began to have a voice and a mind of there on.  We began to ask questions and comparing notes on patient care and what worked best in our monthly nurse’s meeting.  I remember questioning a physician regarding treatment of a patient with high risk of skin breakdown.  I explained to him that several patients on another unit were placed on a low-flow mattress, with a noted decrease in skin breakdown.  He agreed with my suggestion and ordered the mattress. At a monthly nurses meeting, we established a wound care committee and began creating policy and procedures for skin care integrity. There are many hospitals and Long-Term Care facilities today continue to use wound care committees and developing policies and procedures to which I am proud to say I played my part. 

 Yes we all had to find our way back in the 80s to provide the best care we knew how to our patients.  I think of some of the wound care protocols we used back then and cringe because now we know so much more because of research.  Change even now for many is difficult and requires proof that a change is needed.  In education, I ask many times “why are we still teaching this? It is not done like this anymore in real world nursing”  but until I can provide solid proof that times have changed, there will be no change.  

I can relate to not knowing about evidence based practice when I went to nursing school also.  Using evidence to support the best practice instead of just relying on existing practices, nursing care keeps up to date on the newest technological developments (Youngblut, J.M. 2001). I also have worked in wound care and I questioned the doctor about certain treatments that I didn’t agree with.  Usually with my rational & me treating the patients on a daily basis, the wound care doctor would often agree with me. At the facility that I did wound care at, we also used wound care committees and developed policies & procedures and I too had input on some of them.  It is a great feeling to be a part of that and you should always be proud of your contributions.   

I enjoyed reading your post, thanks for sharing. 


Retrieved from 

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Use this document as a checklist for each paper you will write throughout your GCU graduate program. Follow specific instructions indicated in the assignment and use this checklist to help ensure correct grammar and APA formatting. Refer to the APA resources available in the GCU Library and Student Success Center.

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Participation: RN-to-BSN

In discussions, you, as a student, will interact with your instructor and classmates to explore topics related to the content of this course. You will be graded for the following.

1. Attendance

Discussions (graded): Discussions are a critical learning experience in the online classroom. Participation in all discussions is required.

2. Guidelines and Rubric for Discussions

PURPOSE: Threaded discussions are designed to promote dialogue between faculty and students, and students and their peers. In the discussions students:

  • Demonstrate understanding of concepts for the week
  • Integrate scholarly resources
  • Engage in meaningful dialogue with classmates
  • Express opinions clearly and logically, in a professional manner

Participation Requirement: You are required to post a minimum of three (3) times in each graded discussion. These three (3) posts must be on a minimum of two (2) separate days. You must respond to the initial discussion question by 11:59 p.m. MT on Wednesday.

Participation points: It is expected that you will meet the minimum participation requirement described above. If not:

  • You will receive a 10% point deduction in a thread if your response to the initial question is not posted by 11:59 p.m. MT on Wednesday
  • You will also receive a 10% point deduction in a thread if you do not post at least three (3) times in each thread on at least two (2) separate days.

3. NR 447 Week 1 Discussion The Affordable Care Act Recent Threaded Discussion Guiding Principles

The ideas and beliefs underpinning the threaded discussions (TDs) guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The use of TDs provides students with opportunities to contribute level-appropriate knowledge and experience to the topic in a safe, caring, and fluid environment that models professional and social interaction. The TD’s ebb and flow is based upon the composition of student and faculty interaction in the quest for relevant scholarship. Participation in the TDs generates opportunities for students to actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty. TDs foster the development of members into a community of learners as they share ideas and inquiries, consider perspectives that may be different from their own, and integrate knowledge from other disciplines.

4. Participation Guidelines

You are required to post a minimum of three (3) times in each graded discussion. These three (3) posts must be on a minimum of two (2) separate days. You must respond to the initial discussion question by 11:59 p.m. MT on Wednesday. Discussions for each week close on Sunday at 11:59 p.m. Mountain Time (MT). To receive credit for a week’s discussion, students may begin posting no earlier than the Sunday immediately before each week opens. For courses with Week 8 graded discussions, the threads will close on Wednesday at 11:59 p.m. MT. All discussion requirements must be met by that deadline.

5. NR 447 Week 1 Discussion The Affordable Care Act Recent Grading Rubric

Discussion Criteria  A
Outstanding or highest level of performance
Very good or high level of performance
Competent or satisfactory level of performance
Poor or failing or unsatisfactory level of performance
Answers the initial graded threaded discussion question(s)/topic(s), demonstrating knowledge and understanding of concepts for the week.
16 points
Addresses all aspects of the initial discussion question(s) applying experiences, knowledge, and understanding regarding all weekly concepts.16 points Addresses most aspects of the initial discussion question(s) applying experiences, knowledge, and understanding of most of the weekly concepts.14 points Addresses some aspects of the initial discussion question(s) applying experiences, knowledge, and understanding of some of the weekly concepts.12 points Minimally addresses the initial discussion question(s) or does not address the initial question(s).0 points
Integrates evidence to support discussion. Sources are credited.*
( APA format not required)
12 points
Integrates evidence to support your discussion from:

  • assigned readings** OR online lessons, AND
  • at least one outside scholarly source.***

Sources are credited.*

12 points

Integrates evidence to support discussion from:

  • assigned readings OR online lesson.

Sources are credited.*

10 points

Integrates evidence to support discussion only from an outside source with no mention of assigned reading or lesson.Sources are credited.*

9 points

Does not integrate any evidence.0 points
Engages in meaningful dialogue with classmates or instructor before the end of the week.
14 points
Responds to a classmate and/or instructor’s post furthering the dialogue by providing more information and clarification, thereby adding much depth to the discussion.14 points Responds to a classmate and/or instructor furthering the dialogue by adding some depth to the discussion.12 points Responds to a classmate and/or instructor but does not further the discussion.10 points No response post to another student or instructor.0 points
Communicates in a professional manner.
8 points
Presents information using clear and concise language in an organized manner (minimal errors in English grammar, spelling, syntax, and punctuation).8 points Presents information in an organized manner (few errors in English grammar, spelling, syntax, and punctuation).7 points Presents information using understandable language but is somewhat disorganized (some errors in English grammar, spelling, syntax, and punctuation).6 points Presents information that is not clear, logical, professional or organized to the point that the reader has difficulty understanding the message (numerous errors in English grammar, spelling, syntax, and/or punctuation).0 points
Response to initial question: Responds to initial discussion question(s) by
Wednesday, 11:59 p.m. M.T.
0 points lost

Student posts an answer to the initial discussion question(s) by Wednesday, 11:59 p . m. MT.

-5 points

Student does not post an answer to the initial discussion question(s) by Wednesday, 11:59 p . m. MT.

Total posts: Participates in the discussion thread at least three times on at least two different days.
0 points lost

Posts in the discussion at least three times AND on two different days.

-5 points

Posts fewer than three times OR does not participate on at least two different days.

* Credited means stating where the information came from (specific article, text, or lesson). Examples: Our text discusses…. The information from our lesson states…, Smith (2010) claimed that…, Mary Manners (personal communication, November 17, 2011)…. APA formatting is not required.
** Assigned readings are those listed on the syllabus or assignments page as required reading. This may include text readings, required articles, or required websites.
*** Scholarly source – per the APA Guidelines in Course Resources, only scholarly sources should be used in assignments. These include peer reviewed publications, government reports, or sources written by a professional or scholar in the field. Wikipedia, Wikis, .com website or blogs should not be used as anyone can add to these. For the discussions, reputable internet sources such as websites by government agencies (URL ends in .gov) and respected organizations (often ends in .org) can be counted as scholarly sources. Outside sources do not include assigned required readings.
NOTE: A zero is the lowest score that a student can be assigned.

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