NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper

NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Improving Population Health by Working with Communities: The Action Guide is a framework to help multi-sector groups work together to improve population health by addressing 10 interrelated elements for success and using the related resources as needed. Like a “how-to” manual, the Action Guide is organized by these 10 elements and contains definitions, recommendations, practical examples, and a range of resources to help communities achieve their shared goals and make lasting improvements in population health. It is intentionally brief and written in plain language to be as accessible as possible for all types of stakeholders at the local, state, regional, and national levels to take action.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Permalink: nurs-6050-policy…assignment-paper / The 10 Elements include: Collaborative Self-Assessment Leadership Across the Region and Within Organizations Audience-Specific Strategic Communication A Community Health Needs Assessment and Asset Mapping Process An Organizational Planning and Priority-Setting Process An Agreed-Upon, Prioritized Set of Health Improvement Activities Selection and Use of Measures and Performance Targets Joint Reporting on Progress Toward Achieving Intended Results Indications of Salability A Plan for Sustainability Policy and Advocacy for Improving Population Health Developing a Health Advocacy Campaign: Legal and Ethical Consideration NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper The military saying that when one person serves, the whole family serve is correct. Although the service member is the one, who serves and deploys the family is affected by the frequent change in the structure. According to Levy (1984), a book titled Families under the flag written by Edna J. Hunter reviews the issues, conflicts, family roles and stress of the military family. During those times when the book was written, there were not enough organizations and programs to assist the military families. Things have changed since then; programs for the military have included the family and the government has acknowledged their importance in the retention and readiness of the service member. The purpose of this assignment are: to develop a health advocacy campaign for the military family that focused on mental health issue, an effective health advocacy program, a proposal to change the current policy to improve the military family’s situation, a development of an advocacy program, the impact of existing laws and regulations to advocacy efforts, the analysis of methods that can be used to influence legislators, how to overcome obstacles in legislative process, ethical dilemmas that might come up and resolution, the ethical law and reporting requirement, and the evaluation of special ethical challenges.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper An Inter professional Team-Based Health Advocacy Summit In a complex health care environment, nursing and health care professional graduates should be able to understand and collaboratively advocate for health policy benefiting patients, families, and communities. This study explored the effectiveness of inter professional team-based learning to improve political astuteness in undergraduate health profession students. This engaging method may prove to enhance health care professionals’ likelihood of understanding, involvement, and influencing health policy in the future. It is critical that nursing and health care professionals are prepared to collaboratively advocate for health policy. Known as political astuteness , Primomo 1 defined this as an “awareness and understanding of legislative and policy processes and political skills.” 1 (p260) To quantify graduate students’ policy prowess, she used an adapted Clark’s 2 Political Astuteness Inventory (PAI) assessment tool in a health policy course, 1 as well as among RNs and undergraduate nursing students attending a state legislative day. 3 Both studies found significant improvement in political astuteness scores after events focused on health policy education and advocacy. Similar results were attained among 300 baccalaureate nursing students after a student-centered experiential health policy initiative. 4 NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Although traditional education models favor individual learning, a pedagogy that emphasizes engagement within small teams of students to solve conceptual course–related problems is team-based learning (TBL). 5 Using the measure of political astuteness , this study explored the effectiveness of inter professional TBL to address a cutting edge health policy crisis in Virginia, the Medicaid expansion gap . Evidence suggests a disparity between health care providers’ attitudes and experiences regarding health policy advocacy . Physicians’ perceptions of the importance of their role in political advocacy indicate that although 91.6% specified that this was an important aspect of their profession only approximately 25% were politically active. 6 Similarly shocking is a study of health educators’ policy activities, which found that most reported participating in an average of 4 to 5 different activities and/or initiatives per career. 7 Among nutritionists, only 7% report being highly active in the policy-making process, whereas 44% admit no involvement. 8 Surprisingly, 31% of health commissioners stated involvement in public policy advocacy, with only 15% indicating significant knowledge of how to make or change health policy. 9 Barriers to participation were similar in all studies, including time constraints and frustration with the political process, whereas shared benefits included addressing health issues and improving population health.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Nurses also exhibit lackluster enthusiasm and poor understanding regarding the political health policy–making process. 10 A study of 347 RNs indicated that although 73.5% had participated in up to 2 health policy–related activities 26.5 % reported no participation at all. 11 More importantly, 68.8% reported receiving no health policy education in the duration of their nursing studies; of those who did have leisureliness health policy education, 66.7% rated it as poor, 11 highlighting a serious need for a clear emphasis on the health policy–making process.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper From an ethical perspective, nurses and other health care professionals are positioned to advocate for social justice and equality-based health policy. 12 In many cases, a discipline-specific code of ethics exists, requiring health policy advocacy 13 with a professional orientation toward a socially responsible health policy system. 14 For example, because socioeconomic factors adversely affect the health of people in poverty in particular, 14 the National Association of Social Workers advocates for access to comprehensive health care and health services that include appropriate mental, physical, dental, and behavioral health across the life-span 15 through the psychological approach that social workers use. 16 With the growing prominence of social determinants as the major contributors to population health, 17 an inter professional understanding and approach to policy education are vital.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper To ensure political astuteness and engagement, the American Association of Colleges of Nursing’s Essentials of Baccalaureate Education for Professional Nursing Practice and Masters Education in Nursing specifically name health policy education as an expected student outcome. 18,19 Other drivers include the emphasis of the 2010 Patient Protection and Affordable Care Act (PPACA, or more commonly, ACA) on inter professional patient-centered care, population-focused health, and the need to move health care activities into communities. 20 Similarly, a broadening view of the socioeconomic and structural contributions to health set the political context for inter professional health policy education, using policy as a tool to improve population health. 14 For nursing in particular, impetus for health policy education includes specific recommendations from the Institute of Medicine’s (IOM’s) Future of Nursing report 21 to lead change for better population health.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Nurses are teaming with other professions to improve population health, because an inter professional approach to coalition building and community organizing leads to political influence affecting health policy change. Eaton’s 22 example involved coalition building related to nursing education funding and emphasized the power of inter professional stakeholder involvement in the policy-making process. In this case, Virginia nurses, along with the Medical Society of Virginia, the Virginia Hospital and Healthcare Association, and Virginia’s Chapter of American Association of Retired Persons (AARP), collaborated to successfully influence the enactment of legislation increasing funding support for nursing faculty salaries and nursing education.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Little is known, however, about the most effective means to teach and learn health policy in an inter professional environment. 21 Traditional and distance learning health policy courses and curricula have been designed and implemented at both the graduate and undergraduate levels 1,23 to address health policy, process, and advocacy alongside policy theory. However, although several IOM reports explicitly promote inter professional health policy education, these courses are generally homogeneous in nature.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Yet to prepare all health care professionals for collaborative practice, health care quality improvement, and the betterment of population health in the United States, 21,24,25 the need for practice-based inter professional education is evident. Nursing researchers and faculty have commonly used a service-learning approach. For example, O’Brien-Larivee 26 implemented a community participation project that is inherently, although not explicitly, inter professional by incorporating community members and agencies in the baccalaureate nursing students’ education. Frequently, these students engaged in policy assessment and development projects that are integrated into community health nursing clinical practical by placing health policy content in the larger perspective of public health, creating a comprehensive approach to population health. 26-29NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper As an innovative inter professional education pedagogy, TBL enhances student and group understanding while promoting team growth, 24,30 requiring 3 key strategies. First, groups must be managed by the diversity of their individual backgrounds. Secondly, students must be accountable to themselves, the instructor, and their group. This is accomplished through individual and group readiness testing on preparatory material for the particular group assignment or problem. Lastly, students receive feedback throughout the TBL activity from both peers and their instructor(s). All individuals and groups should attempt the same problem, with the actual assignment design being case- or problem-based, requiring course concepts to resolve it, and should therefore elicit simultaneous reporting from all groups. 30NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper This study originated from 2 catalysts. The first was a concerned group of faculty at a large northwestern Virginia university. The second included a request to faculty from Virginia legislators after the enactment of the ACA led to a polarizing nationalized political controversy because lawmakers of The Commonwealth of Virginia declared the Medicaid expansion initiative as unconstitutional. With the state refusing to accept it, 400 000 Virginians became uninsured. 31 During a health policy summit (HPS), students registered in health policy courses developed innovation al projects to address the gap in health insurance coverage for those individuals who do not qualify for Medicaid nor for the Health Insurance Marketplace.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Population health, a field which focuses on the improvement of the health outcomes for a group of individuals, has been described as consisting of three components: “health outcomes, patterns of health determinants, and policies and interventions”. [1] Policies and Interventions define the methods in which health outcomes and patterns of health determinants are implemented. Policies which are helpful “improve the conditions under which people live”. [2] Interventions encourage healthy behaviors for individuals or populations through “program elements or strategies designed to produce behavior changes or improve health status”. [3]NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Policies and interventions are needed due to the inequalities among-st populations and the inconsistent way care is administered. Policies can include “necessary community and personal social and health services” [2] as well as taxes on alcohol and soft drinks and implement smoking cessation policies. Interventions can include therapeutic or preventative health care and may also include actions taken by the individual or by someone on behalf of the individual. The application of population health is determined by the policies and interventions which can be implemented within an organization, city, state or country.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Referring to ‘population health’ rather than the more traditional phrase ‘public health’ also helps avoid any perception that this is only the responsibility of public health professionals. Population health is about creating a collective sense of responsibility across many organizations and individuals, in addition to public health specialists.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Confusingly, the phrase ‘population health management’ is also widely used, with a specific meaning that is narrower in focus than population health. Population health management refers to ways of bringing together health-related data to identify a specific population that health services may then prioritize. For example, data may be used to identify groups of people who are frequent users of accident and emergency departments. This way of using data is also sometimes called ‘population segmentation’. Throughout all these changes in vocabulary, one element has consistently been essential: an emphasis on reducing inequalities in health, as well as improving health overall. This continues to be important in population health.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper There are several definitions of population health in use. The King’s Fund defines it as: An approach aimed at improving the health of an entire population. It is about improving the physical and mental health outcomes and well being of people within and across a defined local, regional or national population, while reducing health inequalities. It includes action to reduce the occurrence of ill health, action to deliver appropriate health and care services and action on the wider determinants of health. It requires working with communities and partner agencies.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper What is involved in improving population health? Our health is shaped by a range of factors, as set out in Figure 1. It is hard to be precise about how much each of these factors contributes to our health, but the evidence is convincing that the wider determinants of health in the outer ring have the most impact, followed by our lifestyles and health behaviors, and then the health and care system. There is also now greater recognition of the importance of the communities we live and work in, and the social networks we belong to.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Figure 1 – What affects our health? The King’s Fund definition of population health leads to a focus on actions in four broad areas, illustrated in Figure 2. These are the four pillars of population health. Figure 2 – Four pillars of population health Improving population health requires action on all four of the pillars and, crucially, the interfaces and overlaps between them. Understanding the interfaces and overlaps between the pillars is essential. For example, housing is well-known to have a powerful impact on health. Healthy New Towns are an example of how an understanding of the overlap between housing, lifestyles and behaviors can lead to housing developments that are designed to encourage physical activity, healthy eating and social interaction. Similarly, sugary drinks have been associated with childhood obesity. Understanding how lifestyle choices – in this case, the choice of drinks – overlap with wider determinants of health – in this case, the affordability of less sugary drinks – helped the government design a soft drinks industry levy (often referred to as a ‘sugar tax’) which has led to a reduction in the sugar content of many soft drinks.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper The King’s Fund describes this way of thinking about population health as a ‘population health system’ in which the four pillars are inter-connected and action is coordinated across them rather than within each in isolation. This is illustrated in Figure 3. Figure 3 – A population health system How should progress be made on population health? The first step is to recognize that improving population health is an urgent priority. Over the last 100 years we have grown used to people living for longer and longer, but in recent years life expectancy has stopped increasing in England and in some areas has been reducing. Health inequalities are widening and England lags behind comparable nations of many key measures of health outcomes. Demand on NHS services has been increasing, but much of that extra demand is for treatment of conditions which are preventable. At heart, the NHS remains a treatment service for people when they become ill.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Importantly, action needs to be taken at three levels: national – eg, government, arm’s length bodies, membership organizations regional – eg, devolution areas, sustainability and transformation partnerships, integrated care systems local – eg, individual cities, towns and neighborhoods. What needs to happen at the national level to improve population health? In addition to The King’s Fund’s A vision for population health , national bodies in England have started to signal a will to prioritize population health. Notably:NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper the Department of Health and Social Care has issued a new strategy Prevention is better than cure which identifies population health as a priority. It includes a commitment for a Green Paper (consultation document) on the specific steps which the government will take to translate that priority into action. NHS England has been increasingly vocal in its aim of reducing health inequalities, and has identified prevention as one of the key themes in the long-term plan for the NHS. The plan includes a welcome emphasis on population health which will be a key focus for integrated care systems as they are rolled out across the country. National leadership for population health is essential but it needs to be coordinated across government. There are different options for how to do so. The last Labor government’s policies set targets for reducing health inequalities which went across government, with accountability through a cabinet sub-committee. The Welsh government has set statutory targets for improving population health, which go beyond the health sector and include requirements for translating them to the local level and for monitoring. The same legislation also set a requirement for health impact assessment of all policies.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper At the moment, efforts to improve population health lack a common set of high-level goals and robust accountability for improvement. Although progress is being made in many local areas, responsibility for this is fragmented and unclear, rather than joined up as a concerted, nationwide approach. Improving accountability for contributing to national, high level goals is a priority. The King’s Fund has highlighted the potentially important role that Public Health England could have in monitoring and reporting on progress across the health and care system and beyond, if its role were more than only advisory. At present, funding is skewed towards health services providing treatment, such as hospitals. There is good evidence that investment in prevention is cost-effective, but the benefits of that investment may not be realized until several years later and, in the meantime, hospitals need the funding now in order to meet people’s immediate needs. Breaking out of this cycle is fundamental to making progress. One of the challenges for national leaders is to lead a debate about how best to re-balance spending across the four pillars of population health.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Policies and Programs As the model shows, policies and programs play an important role in health improvement through their influence on health factors as well as health outcomes. The finite and generally scarce nature of available resources for population health improvement creates an imperative for focusing on those policies and programs that have been shown to be most effective. However, because tight resources also limit the quantity and quality of evidence on any given policy or program, it can be very challenging for those working to improve health to determine the best course of action. Fortunately, a growing number of online resources help point to recommended policies and programs. NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Policies can be implemented at many different levels, from an individual school or worksite to municipalities, regions, states, and even the national level. Examples of effective health policies include smoking bans, excise taxes on cigarettes and alcohol, seat belt laws, water fluoridation, and restaurant menu labeling. There is an increasing call for a “health in all policies” approach among population health academic and practice leaders. Emerging in response to a growing understanding and recognition of the many different factors that influence health, “health in all policies” underscores the need for policymakers in various sectors such as education, housing, transportation, agriculture, development, environment, and others to carefully examine the health implications of the policies they put into place. NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Programs aimed at population health improvement are extremely diverse and address the full range of health determinants/factors. They not only encompass efforts to improve access to health care and individual behavior but also work to create healthy options and opportunities in the environments where people live, learn, work, and play. The determinants of health Introduction Many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper The determinants of health include: the social and economic environment, the physical environment, and the person’s individual characteristics and behaviors. The context of people’s lives determine their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health. These determinants—or things that make people healthy or not—include the above factors, and many others: Income and social status – higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health. Education – low education levels are linked with poor health, more stress and lower self-confidence. Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions Social support networks – greater support from families, friends and communities is linked to better health. Culture – customs and traditions, and the beliefs of the family and community all affect health.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Genetics – inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behavior and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health. Health services – access and use of services that prevent and treat disease influences health Gender – Men and women suffer from different types of diseases at different ages. Foundational Principles of Population Health Policy In 2016, Keyes and Galea issued 9 foundational principles of population health science and invited further deliberations by specialists to advance the field. This article presents 7 foundational principles of population health policy whose intersection with health care, public health, preventive medicine, and now population health, presents unique challenges. These principles are in response to a number of overarching questions that have arisen in over a decade of the authors’ collective practice in the public and private sectors, and having taught policy within programs of medicine, law, nursing, and public health at the graduate and executive levels. The principles address an audience of practitioners and policy makers, mindful of the pressing health care challenges of our time, including: rising health-related expenditures, an aging population, workforce shortages, health disparities, and a backdrop of inequities rooted in social determinants that have not been adequately translated into formal policies or practices among the key stakeholders in population health.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Advocacy has often been described as a key strategy for the achievement of health promotion aims, but multiple and conflicting definitions and usages exist. The concept itself may be unnecessarily intimidating. Advocacy work can take place at the level of both ‘cases’ and ‘causes’. Two main goals underpin health advocacy—protection of the vulnerable (representational advocacy) and empowerment of the disadvantaged (facilitation al advocacy). This paper attempts to integrate existing models and definitions into a conceptual framework for considering the role of advocacy in addressing health inequalities. It argues that we need to pay some attention to the diversity of values and goals of health promotion if we are to understand which models and approaches to health advocacy apply and in what context. This paper concludes that advocacy for health fulfills two functions: as a form of practice and as a useful strategy for a discipline which has to be self-promoting as well as health-promoting in order to survive in the competitive political environment of contemporary health work.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Public health advocacy is often defined as the process of gaining political commitment for a particular goal or program, and identified by some as a critical population health strategy.2,6Target audiences tend to be decision-makers, policy-makers, program managers, and more generally, those that are in a position to influence actions that affect many people simultaneously.4,7,8 Public health advocacy strategies espouse an upstream approach, recognizing that ‘individual’ and ‘personal’ problems are often reflective of social conditions. This approach involves situating ‘individual’ health issues within the broader context of social determinants external to individuals. It also recognizes the societal breadth of many public health problems, and the logistical and resource challenges inherent in approaching these challenges at the individual level. While downstream health promotion activities (such as primary or secondary smoking prevention, community-level interventions and provider education) play an important public health role and should be continued, “…to some they resemble fixing with a pick and shovel what is being destroyed with a bulldozer.”9Engaging in public health advocacy acknowledges the explicitly political aspects of public health, and the importance of addressing social determinants of health as a key component of a strategy for improving the health of populations.NURS 6050 – Policy and Advocacy for Improving Population Health Assignment Paper Put another way, public health advocacy is an important strategy for creating environments supportive of health.10 If the goal of public health is to reduce the societal burden of health problems, then effective interventions must “…alter the societal forces that foster these problems.”11 Ignoring the social and political dimensions of health has the effect of relegating public health practice to the “…prevention and promotion of individual risk factors.” Advocacy strategies draw from a range of tactics. These can involve “…creating and maintaining effective coalitions, the strategic use of news media to advance a public policy initiative and the application of information and resources to effect systemic changes that change the way people in a community live. It often involves bringing together disparate groups to work together for a common goal.”13 It can also involve gathering and presenting an evidence-base for desired changes, although it is worth noting that scientific evidence alone is rarely enough to achieve desired political support for public health goals. Evidence is often a necessary – but rarely sufficient – factor for influencing policy processes. The Ontario Health Promotion Resource System categorizes advocacy activities as low, medium, and high profile. Low profile activities could include quiet negotiation, meetings with civil servants, sharing information, and the development of non-public briefs. Medium profile activities include on-going negotiation, development of public briefs, ‘feeding’ the opposition, giving deputations at committees, participating in meetings with elected officials, forming strategic alliances with other groups, and writing letters to elected officials or newspapers. High profile activities include public criticism, public relations activities, advertising campaigns, information distribution, letter writing, and participation in demonstrations and rallies.14Within this categorization system, many activitie

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