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

Sample Answer for NURS 6050 The Role of the RN/APRN in Policy Evaluation Included After Question

By Day 3 of Week 9

Select an existing healthcare program or policy evaluation or choose one of interest to you.

Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.

Post an evaluation topic and a brief description of the evaluation. Discuss how social determinants impact this issue.

By Day 6 of Week 9

Respond to at least two of your colleagues* on two different days by suggesting additional opportunities or recommendations for overcoming the challenges described by your colleagues.

A Sample Answer For the Assignment: NURS 6050 The Role of the RN/APRN in Policy Evaluation

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

Policy evaluation uses a range of research methods to systematically investigate the effectiveness of policy interventions, implementation and processes, and to determine their merit, worth or value in terms of improving the social and economic conditions of different stakeholders.

It is important to understand how policy evaluation fits into the larger policy process. Understanding this context provides an increased understanding of why policy evaluation is critical to advancing the field of policy. Although there are many theories regarding the policy process and mechanisms of policy change, the policy change process is often conceptualized in several key stages. Evaluation is an integral part of each step in the policy process. Although these steps are laid out in a row, in reality, the steps are circular in nature. 

The three types of evaluation: 

Evaluating Policy Content: Does the content clearly articulate the goals of the policy, its implementation and the underlying logic for why the policy will produce intended change? Evaluating the development of a policy helps to understand the context, content, and implementation. 

Evaluating Policy ImplementationWas the policy implemented as intended? The implementation of a policy is a critical component in understanding its effectiveness. Evaluation of policy implementation can provide important information about the barriers to and facilitators of implementation and a comparison between different components or intensities of implementation. 

Evaluating Policy Impact: Did the policy produce the intended outcomes and impact? Within injury prevention, the intended impact may be a reduction in injuries or severity of injuries. However, it is important to evaluate short-term and intermediate outcomes as well. 

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The type of evaluation selected depends on many factors and often more than one type of evaluation will be needed. Each type of evaluation can provide valuable information for the planning and interpretation of the other types of evaluation (content, implementation, and impact) in addition to uncovering unintentional consequences. However, it is critical for each evaluation to be focused so the most appropriate design and methodology is selected. The team can develop an all-encompassing set of evaluation questions and then select specific evaluation questions and methods for each particular phase.

While all evaluations encounter challenges particularly relevant to policy evaluation and many of these challenges can be easily addressed by using an appropriate design, indicators, and methods. The challenges  when conducting policy evaluation are:

  • Lack of resources or clear responsibility for evaluation 
  • Lack of strong evidence base to support policy 
  • Fear of evaluation and lack of familiarity with policy evaluation methods 
  • External and contextual factors such as economic conditions or public awareness 
  • Rapid pace of policy 
  • Lack of appropriate measures 
  • Political scrutiny and desire for quick production of results 
  • Difficulty in identifying appropriate comparison communities

References

Brownson, R. C., Royer, C., Chriqui, J. F., & Stamatakis, K. A. (2009). Understanding evidence-based public health policy. American Journal of Public Health, 99, 1576–1583.

MacDonald, G., Starr, G., Schooley, M., Yee, S. L., Klimowksi, K., & Turner, K. (2001). Introduction to program evaluation for comprehensive tobacco control programs. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/tobacco/tobacco_ control_programs/surveillance_evaluation/evaluation_manual/pdfs/evaluation.pdf

A Sample Answer 2 For the Assignment: NURS 6050 The Role of the RN/APRN in Policy Evaluation

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

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.          

NURS 6050 The Role of the RN APRN in Policy Evaluation
NURS 6050 The Role of the RN APRN in Policy Evaluation

            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.

A Sample Answer 3 For the Assignment: NURS 6050 The Role of the RN/APRN in Policy Evaluation

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

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.

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)

A Sample Answer 4 For the Assignment: NURS 6050 The Role of the RN/APRN in Policy Evaluation

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

Affordable Care Act (ACA) can also be measured through the promotion of personal well-being. If ACA prevents and relieves pain suffering and disability and minimizes loss of life, then it’s doing what it was designed to do.

Affordable Care Act can also be measured through its effect on meeting people’s health needs as the disease is usually thought of as an adverse departure from the normal level of functioning. The ACA should therefore help people to maintain or restore normal functioning or to compensate for the inability to function normally.

Another way ACA is measured is through equitable access. Equitable access could be interpreted as access to whatever an individual needs or benefits from. For instance, if a given level of care is available to one individual, it must be available to all. ACA was designed to ensure that there is equitable access to healthcare for all individuals who enjoy healthcare benefits (Munson & Lague, 2016)

References

Milstead, J. A. (2014). Health policy and politics (5th ed.). Jones & Bartlett Learning.

Munson, R., & Lague, I. (2016). Intervention and reflection: Basic issues in bioethics (10th ed.). Cengage Learning.

A Sample Answer 5 For the Assignment: NURS 6050 The Role of the RN/APRN in Policy Evaluation

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

Thank you for an excellent post. Advanced practice registered nurses is on the front lines of disseminating information to patients that directly affect their outcomes to treatments and medications. We constantly assess, administer treatment and medications and then evaluate that treatment, but seldom do we use those skills to evaluate the policies that have been enacted governing the treatments or medications we administer. Many healthcare policies and programs have been established, but it is critical to determine whether they have been efficient and effective. Efficiency details the number of patients helped, and effectiveness speaks to the quality of care. Evaluation reports are provided by the programs to share specific information that aids members of the legislature, community, and others in understanding how the program works and its impact on the targeted recipients (Walden University, LLC, 2018). Since 1992, more than $8 billion have been delivered for over 360,000 Virginians, almost 150,000 Virginians have received state-sponsored health insurance, almost 4 million patient visits have happened, and more than $16 million in grants given to expanding the state’s medical safety (Foundation, n.d.). The VHCF is very efficient with the number of Virginians it has supported in its 30-year presence. The program’s efficacy is evident by the evidence of expanded health care services to areas of the state that were previously under or not served. In 2021, the priority was on developing mental health care services for those without access to counseling services.

References

Foundation, V. H. C. (n.d.). RD441 (published 2021) – Virginia health care foundation 2021 Annual report. Retrieved October 28, 2022, from https://rga.lis.virginia.gov/Published/2021/RD441

Walden University, LLC. (Producer). (2018). The Importance of Program Evaluation [Video file]. Baltimore, MD: Author.

A Sample Answer 6 For the Assignment: NURS 6050 The Role of the RN/APRN in Policy Evaluation

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

Health policies are frequently developed without the evidence of research conducted by nurses (Wakefield, 2004). I believe that by increasing nurse researchers’ understanding of the policy process and how research contributes to policy evaluation, nurse researchers will be more effective in contributing to policies that improve the health of the nation.

Evaluation is the final stage in the policy process. Policy evaluation according to the Centers for Disease Control and Prevention (CDC) applies evaluation principles and methods to examine the content, implementation or impact of a policy, it is the activity through which we develop an understanding of the merit, worth, and utility of a policy (CDC, 2016). Moreover, the use of research to health policy evaluation is to determine the effectiveness of the healthcare policy in improving aspects of targeted population’s health in terms of quality of care, the efficiency of care delivery, availability of access and the effect on health disparities. 

As nurses being involved in the process of policy evaluation, nurses should be encouraged to engage more fully in health policy research. We believe that by increasing nurse researchers’ understanding of the policy process and how their research can contribute at each stage of the process, nurse researchers will be more effective in contributing to policies that improve the quality of health of the target population

References

Aday L. A., Begley C. E., Lairson D. R., Balkrishnan R. (2008) Evaluating the healthcare system: Effectiveness, efficiency, and equity, 3rd ed. Chicago, IL: Health Administration Press.

Braveman P. A., Cubbin C., Egerter S., Williams D. R., Pamuk E. (2010) Socioeconomic disparities in health in the United States: What the patterns tell us. American Journal Public Health 100(Suppl 1): S186–S196. doi:10.2105/AJPH.2009.166082.

Evaluation Topic: Affordable Care Act

In 2010, the United States government passed a law called the Patient Protection and Affordable Care Act (eHealth Insurance, 2022). Its goals included expanding access to health insurance, ensure that every American could afford health insurance and bettering the quality of healthcare for all Americans (eHealth Insurance, 2022). Several parts of the Affordable Care Act facilitate increased access to insurance, a broader selection of therapies for patients, and stronger healthcare delivery systems. The reform has resulted in vast improvements to health insurance in the United States.

Outline of the Evaluation

Considering the ACA’s stated aims of increasing access, decreasing costs, improving quality, and addressing social and economic determinants of health. The success of the ACA was evaluated using both numerical and qualitative metrics. Quantitative criteria included the overall cost of health care in the United States, the percentage of the population without health insurance, the availability and cost of specific medical procedures and treatments, and so on (Kenton, 2022). The quality of care provided to patients since the adoption of the Affordable Care Act was evaluated based on survey data collected from patients, feedback from stakeholders, and healthcare providers’ responses to surveys about the quality of care they have been able to provide.

Sign-up rates, coverage retention rates, premium prices, and the availability of doctors and hospitals that accept the Affordable Care Act were only few of the measures used to evaluate the success of the program. The success of the program was measured in a number of ways (Center on Budget and Policy Priorities, 2019): by the number of people who signed up, by how many of them kept their coverage, by how much it cost to maintain, and by how many medical professionals were willing to take ACA patients.

 Social Determinants

Examples of social determinants of health include a person’s living conditions, working conditions, and social environment. The Affordable Care Act (ACA) has made some efforts to address the socioeconomic determinants of health, such as poverty, education, access to healthy food and transportation, and exposure to violence.Urban neighborhoods have benefited greatly from a method of gauging a project’s success that compares the access to healthcare experienced by people of varying racial and ethnic backgrounds who live in urban and rural settings.

Conclusion

Any evaluation of the Affordable Care Act’s success should focus on improving health outcomes and expanding access to health care for vulnerable populations. The goal is to give a balanced assessment of the ACA so that policymakers in Washington may make well-informed decisions about the future of health care in the United States.

References:

Chart book: Accomplishments of affordable care act. Center on Budget and Policy Priorities. (2019b, March 19). https://www.cbpp.org/research/health/chart-book-accomplishments-of-affordable-care-act 

eHealth Insurance. (2022). History of the Affordable Care Act (Obamacare) | eHealth. www.ehealthinsurance.com. https://www.ehealthinsurance.com/resources/affordable-care-act/history-timeline-affordable-care-act-aca

Kenton, W. (2022b). Affordable Care Act (ACA): what it is, key features, and updates. Investopedia. https://www.investopedia.com/terms/a/affordable-care-act.asp

There are several local, state, federal healthcare programs and policies that need assessment. The healthcare policy evaluation’s focus is on “The availability of healthcare in low-income areas”. According to National Academies of Sciences, Engineering, and Medicine 2017, having access to quality medical care is a fundamental human right and fundamental to the health and wellbeing of individuals and communities everywhere. Those in low-income areas face significant barriers when trying to access medical care, unfortunately. As a result, this contributes to both poor health outcomes and health disparities. That people can get the care they need, when they need it, is what is meant by “access to healthcare services.” It addresses the availability, affordability, and quality of healthcare services. People who struggle to gain access to healthcare are at a higher risk for a variety of undesirable consequences, including increased rates of disease and mortality, a shortened life expectancy, and a diminished quality of life.

Worldwide, people, and communities are affected by the lack of access to healthcare. People in low-income areas often face significant barriers when seeking to access healthcare, including issues of cost, accessibility, and availability. Evaluation of access to healthcare in low-income communities must take into account the services’ availability, cost, accessibility, and quality. The availability of medical treatment is strongly influenced by socioeconomic factors in low-income communities, such as residents’ income, race/ethnicity, level of education, and geographical location (Centers for Disease Control and Prevention, 2019). For instance, persons with lower incomes are disproportionately affected by barriers to healthcare access, such as a lack of financial resources or insurance coverage. Racial and ethnic minorities confront healthcare disparities due to bias, linguistic barriers, and a lack of culturally competent care. People in rural or remote areas face additional barriers in accessing healthcare due to a shortage of healthcare practitioners and restricted transportation choices (National Academies of Sciences, Engineering, and Medicine, 2017).

To improve the availability of healthcare for low-income populations, it is crucial to tackle these social determinants of health. This includes initiatives to increase the availability of healthcare experts in underprivileged areas, provide transportation to medical facilities, and broaden access to affordable health insurance. By providing culturally competent care and working to eliminate discrimination, we can ensure that people of all races and ethnicities have equal access to medical services. When compared to the national median household income, a community is deemed low-income if the income of its residents is much lower than the national average. (Council, Institute of Medicine, and National Research, 2017). Residents in low-income areas are more likely to face healthcare access barriers due to factors such as socioeconomic status, race and ethnicity, level of education, and physical location. Social determinants of health refer to a person’s exposure to economic, social, and environmental factors. There is evidence linking these variables to health outcomes for the individual. The above social variables have a substantial effect on low-income groups’ access to healthcare.

According to Council, Institute of Medicine, and National Research (2017) poverty is a significant socioeconomic determinant of health that influences access to medical care in low-income populations. Low-income people often have trouble getting the medical care they need because they can’t pay it or aren’t covered by insurance. In the United States, for example, people with lower means are more likely to lack health insurance, creating significant barriers to receiving necessary medical care. To address this issue, the Patient Protection and Affordable Care Act (ACA) was signed into law. By extending Medicaid and providing subsidies for private insurance, the ACA aims to increase access to affordable health coverage for low-income individuals and families.

In conclusion, healthcare access is a basic human right; unfortunately, people in low-income communities often face significant barriers when trying to access healthcare. Poverty, racial/ethnic identity, educational attainment, and geographic location are all important social determinants of health that affect low-income individuals’ access to healthcare. By implementing policies to increase access to affordable health insurance, remove barriers related to transportation, ensure culturally competent care, and increase the number of healthcare providers working in underserved areas, we can improve healthcare access and outcomes for individuals living in low-income communities.

I definitely agree with you that as nurses, we have the opportunity to evaluate policies every day as we implement them. I also agree that the administration is not always open to feedback. This was one of the frustrations I used to experience when I worked as a floor nurse. I vowed that when I got into nursing leadership, I would do things differently and change this trend.

Therefore, when I became a Director of Nursing, I decided to implement measures in place that would encourage my nurses to feel free to approach me with any suggestions or ideas. The first thing I did was to have an open-door policy. I let my nurses know from the get-go that I was open to suggestions on how we could improve our systems and policies in place to ensure we were providing quality, safe, care to our residents. Anytime a nurse would come to me with a suggestion, I would listen to them and take the suggestion seriously into consideration. I would acknowledge them by thanking them for their suggestion, then, I would carry out some research on it. I would then get back to that nurse with feedback. If their suggestion led to us making changes to a policy, I would involve them in making the necessary changes, then would have them help me implement and educate the other staff about the changes made. I would then re-evaluate the changes made to ensure they were working appropriately. This saw a lot of my staff members being motivated to share ideas and suggestions with me. 

A good example I would like to share was when my wound nurse coordinator approached me with the concern of CNAs putting a lot of layers on mattresses for residents’ high risk for pressure ulcers. He brought it to my attention that the wound care team would find an undersheet, 2 thick incontinence pads, folded draw sheets, then a diaper on the residents. He explained to me that they noticed that it was interfering with pressure ulcer prevention and care. The multi-layers of linen were preventing the air mattress from providing the relief that it was intended to do to prevent pressure ulcers. I then reviewed our policy on pressure relieving devices and noticed that we did not have a clause in the policy that would guide us on how many pieces of linen should be on a special air mattress.

I then gave him feedback and sat down with him to include this clause in our pressure ulcer prevention policy. I then had him spearhead the education of this change in policy by having him in-service the staff members and showing them the recommended layers of linen on a special mattress. Thereafter, I created a QAPI tool for him to use as they were doing their wound care rounds, and any resident found with more than 2 pieces of linen, he would bring it to my attention. I would then call the staff member working with that resident, and together with my wound care coordinator use it as a teaching moment, reminding the staff member that if this happened again, further disciplinary action would be taken. He felt so validated that he started sharing with other nurses how I followed up on ideas from my staff. This in turn saw more of my staff approaching me with suggestions and ideas. 

Initial Post

     As an emergency room nurse in a level one trauma center and pediatric hospital, I have had to provide care for many children.  Young children are often treated in the emergency room for unintentional and often preventable medication overdoses, a life-threatening situation.  This discussion seeks to discuss the evaluation of the Center for Disease and Control’s PROTECT healthcare program.

Evaluation Topic

     The Centers for Disease and Control (CDC) has implemented a healthcare program focusing on medication safety.  Prevention of Overdoses and Treatment Errors in Children Task Force (PROTECT) is a program that collaborates with public health agencies, private companies, professional organizations, consumers, and academic experts to help keep children safe from unintentional medication overdoses (Centers for Disease Control and Prevention, 2023a).  PROTECT aims to focus on safer use, safer packaging, and safer storage of medications (Centers for Disease Control and Prevention, 2023a).  The CDC and Healthy People 2030 recognize this is a serious health concern as emergency medical treatment is often needed.

Description of the Evaluation

     An objective of Healthy People 2030 is to reduce emergency department visits for children less than five years of age due to medication overdose (Healthy People 2030, n.d.).  The PROTECT program uses this objective as its measurable goal for success (Centers for Disease and Control, 2023b).   National data is collected on emergency department visits for childhood medication overdoses, and education through the PROTECT program is used to meet the objective (Centers for Disease and Control, 2023b).  After evaluating the PROTECT program, it is noted that progress has been made through packaging improvements, error prevention, and education on safe storage and use of medications (Centers for Disease and Control, 2023b). 

Impact of Social Determinants

     Social determinants of health significantly impact health, well-being, and quality of life (Healthy People, n.d.).  Social determinants significantly affect this issue of unintentional medical overdoses in children.  The environment, education, access to care, economic stability, and community contexts all influence this issue.  The PROTECT program seeks to provide the needed resources and education to allow people to overcome these social determinants.

References

Centers for Disease Control and Prevention. (2023a). Protect initiative: Advancing

Children’s medication safety. https://www.cdc.gov/medicationsafety/protect/protect_initiative.html 

Centers for Disease Control and Prevention. (2023b). About protect.

https://www.cdc.gov/medicationsafety/protect/about.html

Healthy People 2030. (n.d.). Social Determinants of Health.

https://health.gov/healthypeople/priority-areas/social-determinants-health