Challenges in Contemporary Healthcare: An Overview

In reviewing the Affordable Care Act, what are the potential effects of the options for insurance coverage in both the private and public sectors? How will this impact the discussion about population-based nursing?

The Affordable Care Act has provided new opportunities for addressing some of the most contentious public health concerns and the associated financial concerns. The issue of health insurance is particularly important to the management of public health concerns due to the implications that it has on the well-being of U.S. citizens. According to the key provisions of the Affordable Care Act, public sectors should receive especially copious amounts of financial support for health services (Kennedy, Wood, & Frieden, 2017). Specifically, the Affordable Care Act implies an increase in the eligibility for insurance in the public health sector, at the same time introducing a more lenient approach toward cost management (Kennedy et al., 2017). Similarly, the ACA has expanded the range of opportunities for private sector insurance coverage (Kennedy et al., 2017). As a result, U.S. citizens receive a larger number of chances to receive proper public health services based on the changes to the insurance structure that has been implemented with the help of the Affordable Care Act.

The described change is bound to have an especially powerful impact on the efficacy of population-based nursing. By definition, the latter implies that the needs and health issues of a particular group of people are reviewed and addressed correspondingly (Curley & Vitale, 2015). The use of the ACA, in turn, suggests that the population-based nursing approach is integrated into the modern healthcare context since the ACA principles allow addressing a health concern on the level of specific social and ethnic groups (Curley & Vitale, 2015). Creating the premises for the analysis of health indicators that are associated with a particular group, the ACA has enhanced population-based nursing.

Identify a population-based problem of interest, such as obesity among children. After reviewing topical information in Healthy People 2020 and The Community Guide to Preventive Services, identify relevant outcomes related to this problem that will help guide your plans for intervention.

Despite numerous efforts to manage the problem of heart disease and stroke among the elderly, the issue remains a source of concern for nurses. Studies show that the propensity toward a stroke and the development of heart disease increase with age (Huynh-Hohnbaum, Marshall, Villa, & Lee, ‎2015). Therefore, creating a framework for addressing the observed public health issue is critical. One has to admit that several programs have been launched to curb the levels of threat of a stroke among senior citizens (Huynh-Hohnbaum et al., ‎2015). However, while having a minor effect in certain communities, the described programs have had little impact on public health in the grand scheme of events (Huynh-Hohnbaum et al., ‎2015). Therefore, changes have to be made on a global level based on the Healthy People 2020 goals (“Older adults,” 2019).

According to The Community Guide to Preventive Services (“Summary of CPSTF finding,” 2015), the issue of health stroke in the elderly typically leads to fatal outcomes unless prevented properly. Therefore, creating a program that would allow building awareness regarding heart disease and the threat of a stroke among aging people should be seen as an important step toward managing the issue. The program aimed at reducing the propensity toward heart disease among the elderly needs to include an increase in the quality and consistency in communication between a nurse and a patient as one of the critical outcomes. By enhancing the dialogue between a patient and a nurse, one will cause a gradual increase in awareness among the elderly and help them to detect threats to their health, as well as address healthcare experts.

How could you use descriptive epidemiological methods in your practice? Provide an example where you could use descriptive epidemiology to improve care. Explain your rationale.

Locating determinants of health, including social factors, ecological ones, and other influences that may affect an individual’s health is critical for the enhancement of care. Therefore, the application of epidemiology in the modern healthcare context is critical to the delivery of the required patient outcomes. In personal healthcare practice, descriptive epidemiology could be used to build an in-depth understanding of how a particular disorder develops in a target population (Mishra, 2018). Specifically, the issues such as the presence of social prejudices, the lack of economic and financial resources, the absence of technological tools for monitoring health levels, and the quality of communication between a patient and a nurse will have to be considered. By exploring the identified issues, one will be able to improve public health levels significantly.

The rationale behind using epidemiology tools for addressing some of the current public health issues is rather basic. By utilizing the proposed tools, one will be capable of improving the quality of care and creating the environment for addressing health issues in a timely and effective fashion (Pope & Stanistreet, 2017). Specifically, the application of epidemiological methods will allow using evidence-based research and practice to ensure that the needs of each patient are addressed accordingly and managed properly. Descriptive epidemiology will help to explore the nature of health issues, thus building a profound understanding of their causes and the methods of addressing them. Thus, the use of descriptive epidemiology as the method of managing health issues faced within a particular community, such as epidemics or diseases caused by specific socioeconomic factors, should be considered necessary.

Which epidemiological study design would you use to evaluate an intervention in your practice? Provide a description of the chosen population and the identified intervention. Provide support as to why you believe that the design you chose is the best option including the strengths and weaknesses of the design you have chosen.

In my practice, the use of incidence case-control studies seems to be the most legitimate approach toward exploring a specific problem and addressing it. The rationale behind the choice concerns the large rates of diversity within the global community and the necessity to create a uniform approach that would, later on, be adjusted to the needs of specific populations. For instance, in order to manage the problem of high heart disease rates within a local community, I will apply the incidence case-control study to determine the factors defining the prevalence of heart disease issues among members of different population groups, including age- and ethnicity-based analyses. Thus, an all-embracive assessment of the problem will be conducted (Petersen, Douglas, & Whitaker, 2016). The selected epidemiological study design is perfect for addressing the needs of diverse populations due to its capacity to incorporate a vast array of factors for the analysis.

The opportunities that the incidence case-control study provides for managing the needs of diverse communities can hardly be overrated. The adoption of the proposed technique leads to the successful management of population-specific health issues, as well as a profound understanding of community members’ needs. Moreover, it allows building nurse-patient communication by examining closely the factors that affect community members. However, one should also bear in mind that the use of the incidence case-control analysis is likely to take a significant number of resources, i9ncluding primarily financial ones (Boehme et al., 2016). Therefore, it is highly recommended to apply the proposed tool once the available financial assets are allocated reasonably. Thus, the populations that are currently at risk of developing a particular disease or disorder will be provided with the necessary services.

Provide examples of measures that APNs can collaborate with direct care nurses in implementing evidence-based changes to improve health literacy in practice.

Interdisciplinary collaboration is critical for the successful management of patient’s needs, yet nurses may face difficulties when establishing a cross-disciplinary dialogue, especially in a setting that involves a large amount of stress (Liu, Gerdtz, & Manias, 2016). Therefore, introducing the tools that will allow enhancing collaboration between APNs and direct care nurses is critical. While the latter can provide excessive amounts of evidence-based insights, the former can create theories that will lead to the further creation of EBP, patient-specific approaches for treating diseases. The process of designing a unique intervention for a certain population, in turn, will require cooperation between APNs and direct care nurses. Unless collaboration based on nursing ethics and focus on patients’ needs is promoted in the selected environment, the threat o medical errors and similar problems will increase drastically.

When choosing the measure for enhancing cooperation between APNs and direct care nurses, one should pay special attention to the arrangement of roles and responsibilities thereof. Specifically, it is necessary to create scenarios in which APNs and direct care nurses will need to communicate and discuss the obtained evidence to produce patient-specific interventions. In addition, conflicts caused by the current hospital hierarchy will have to be prevented by reinforcing the idea of cooperation and subverting the stereotypes regarding the status of direct care nurses in the hospital setting (Kutzleb et al., 2015). Specifically, APNs and direct care nurses will process and arrange the available data regarding the target community to keep patients and their family members informed about relevant health issues.

Describe an example where a patient’s culture could impact health literacy. What measures would you employ to address the health literacy barrier? How effective is the current protocol for implementing practice changes in your institution? Examine any barriers and the facilitators for implementing an evidence-based change in your specific setting?

The promotion of health literacy is a crucial step in preventing complex health issues and reducing the threat of epidemics within a particular community. Therefore, patient education needs to be regarded as critical (Jacobs, Lou, Ownby, & Caballero, 2016). However, to increase the rates of health literacy among patients, a nurse has to take cultural characteristics of patients into account; otherwise, establishing a dialogue between the recipient of care and the provider thereof will be impossible. For instance, in the scenario that involves catering to the needs of an immigrant whose health beliefs are rooted in traditional medicine, it is essential to focus on addressing their health literacy on a family level, thus creating the setting in which a patient will be supported in their choice of modern medicine (Nguyen, Paasche-Orlow, Kim, Han, & Chan, 2015). Thus, the literacy barrier will be removed, and a patient will start acquiring the necessary information.

In my institution, the protocol for implementing evidence-based change can be described as quite effective, mostly due to the focus on cross-cultural communication between a nurse and a patient. Combined with the active learning aimed at both a patient and a nurse, the specified framework helps to establish a healthy approach toward the subject matter (Jacobs et al., 2016). By deploying the strategy used at my institution, nurses encourage patients to develop independence by learning to use actively health-related resources, including both traditional and modern media (Nguyen et al., 2015). Thus, the levels of health literacy among target populations increase exponentially. The protocol is expected to motivate nurses to use multicultural skills to address complicated situations during interdisciplinary communication and while establishing a nurse-patient dialogue.

What do you see as the largest health concern affecting underdeveloped countries? What role does the DNP play in eradicating this concern? What would be the first steps?

Underdeveloped countries are currently on the brink of a health crisis due to the unavailability of the required resources and the absence of decent health support. The array of issues that residents of these states face are vast and mostly interrelated since all of them stem from the lack of resources for maintaining the quality of care at the required level. However, when it comes to selecting the factor that has the greatest impact on the well-being of citizens in underdeveloped states, one should mention the problem of water pollution first. Due to the high rates of water contamination, the transfer of infectious diseases increases exponentially in underdeveloped states and underserviced areas, causing epidemics and claiming the lives of hundreds of people (World Health Organization, 2019). The contamination of water leads to the pollution of lands and the further negative impact on agricultural products, ultimately affecting people through the food that they consume (Sun, Dohrn, Omoni, Malata, Klopper, & Larson, 2016). Thus, changes are needed to manage the described issue.

From a DNP’s perspective, the described problem requires a change in several levels, the issue of resource management and technology being the key one. By reconsidering the existing approach toward water sanitation in the specified states and providing citizens with the necessary equipment, one will cause a gradual drop in the instances of epidemics. However, it is also critical to ensure that patients are provided with basic information about maintaining good health and addressing threats to their well-being (Bekelman et al., 2016). Thus, improvements can be expected within a comparatively short span of time.

In the assigned article, “Attention to Local Health Burden and the Global Disparity of Health Research,” the authors discussed the lack of attention given to global health crisis research. What areas can the DNP address that will promote health in correlation with the WHO’s Commission on Social Determinants of Health?

The issue of the global health crisis is becoming evident with every new health concern emerging on the horizon. With the rise in the unavailability of healthcare services and resources, particular attention should be given to the analysis of the factors that contribute to the enhancement of the global crisis and the aggravation of the concern. Therefore, the DNP needs to collaborate with the WHO in order to locate the factors that contribute to the aggravation of the existing situation. Furthermore, by studying the social determinants of health for specific populations, the DNP will be able to manage the issue on a local level (Jeffreys, 2015). For this purpose, the areas such as family mental health, pediatric care, and leadership, and innovations in healthcare need to become the focus of the DNP’s health promotion programs.

By focusing on the identified areas, one will create the setting for addressing the needs of the most vulnerable groups, which currently include children and senior citizens. Moreover, the enhancement of family care will reinforce family connections and contribute to a gradual rise in the levels of family support for patients. The resulting change in patients’ motivation and enthusiasm will have a vastly positive impact on their recovery rates (Foronda, Baptiste, Reinholdt, & Ousman, 2016). By analyzing the described areas, nurses will identify social determinants of health associated with communication, family interactions, community issues, and other culture-related factors that affect patients’ health to the greatest degree. Therefore, promoting the specified areas of health management is critical to the improvement of patient outcomes.

Analyze the ANA’s definition of the nurse’s role in ethics and human rights and the role of the DNP in eliminating health disparities.

A nurse plays a crucial role in enhancing the significance of human rights and ethical guidelines in healthcare. The official statement of the American Nurse Association (ANA) defines the role of a nurse in ethics as crucial, claiming that it is the responsibility of a nurse to promote ethically sensible approaches toward meeting patients’ needs. For instance, the ANA Code states the following: “The American Nurses Association believes that respect for the inherent dignity, worth, unique attributes, and human rights of all individuals are a fundamental principle” (American Nurse Association, 2016, para. 2). Therefore, it is essential to create a setting in which a nurse can promote patient-oriented care and focus on meeting the needs of diverse populations.

A DNP is, in turn, responsible for educating ethics to nurses and ensuring that the established ethical standards are followed precisely. A DNP regulates the nursing process so that the actions taken by nurses could meet the current standards of ethics (Edmonson, McCarthy, Trent-Adams, McCain, & Marshall, 2017). Furthermore, like the one addressing ethical issues occurring in the nursing setting, a DNP is supposed to manage the instances of health disparities and handle the cases that involve any form of inequality or discrimination against patients. Thus, equal opportunities are provided to the target demographic (American Nurse Association, 2016). The described changes are implemented with the help of ethical principles such as trust and humility, as well as the active use of the community’s strengths and developing awareness about social determinants of health within a particular community.

Provide an evaluation of the current political climate related to health care and define how the DNP can positively impact through policy or advocacy.

Although the effects that politics produces on the healthcare environment are often dismissed as irrelevant, political changes produce a resonant effect on the quality and efficiency of healthcare services. For instance, the creation of a favorable political climate is likely to have a profoundly positive effect on healthcare services and the well-being of citizens. The current political climate in regard to its effect on healthcare can be described as vast and multifaceted. For instance, the recent adoption of the Affordable Care Act has opened a plethora of opportunities for improving the effects of healthcare and addressing the economic gap that prevented people from receiving proper care in the past (Glied & Jackson, 2017). At the same time, certain regulations still pose obstacles to the successful management of patients’ needs. For example, the current tendencies observed in the political arena indicate that the current political trends define whether a particular policy should be implemented.

In addition, current political tendencies shed light on the issues that vulnerable groups are facing nowadays. For instance, with the rise in awareness regarding the needs of the LGBT community and the challenges that LGBT members experience, healthcare services became more sensitive toward the plight of the identified minority group. However, the observed tendency is also correct for the opposite phenomena; for example, with the recent changes in the U.S. migration regulations, healthcare options for immigrants have been reduced significantly (Martinez et al., 2015). Consequently, nurses will produce treatment options that will be adjusted to the needs of specific patients.

In creating a new community-based health program, what program development model would you use? What recommendations would you employ for making the program development successful?

Community-based health programs are critical for the enhancement of health literacy and improvement of health outcomes among community members. However, in order to create an effective program, a DNP has to consider a program development model that will become the platform for promoting change. Since embracing the diversity of a community is seen as one of the key goals of a DNP, it will be necessary to deploy the Extension Program Development Model. By definition, the Extension Program Development Model provides a chance to integrate the tools for catering to the needs of diverse populations (Garst & McCawley, 2015). In addition, the program implies using education as the key to improving the quality of healthcare. The described goal should be seen as twofold since it has to be aimed at both patients and nurses to achieve success. While patients will acquire critical self-care skills, nurses will gain the information required for successful cross-cultural patient-nurse communication.

To ensure that the proposed program is implemented in the designated setting successfully, one should encourage multidisciplinary communication between nurses, at the same time providing patients with educational resources. Furthermore, increasing the quality of the patient-nurse dialogue should also be deemed as an important objective (Vandiver, Anderson, Boston, Bowers, & Hall, 2018). Particularly, creating a community-based network where nurses could share health-related information with the community and keep people informed about key health issues is required. Thus, the levels of self-care will rise significantly among patients, which will ultimately lead to significant improvements in their recovery rates.

How can large, aggregated databases be used to improve population health?

With the increase in the amount of data that has to be processed to address the needs of a particular population, the importance of aggregated databases has risen (Felkey & Fox, 2015). At present, it is critical to be able to arrange the available data to build the knowledge system that contributes to enhancing population health. Aggregated databases allow managing all patient data when addressing their health needs and managing health concerns. Thus, an all-embracive assessment of a patient’s health status becomes possible (Wells, Ozminkowski, Hawkins, Bhattarai, & Armstrong, 2016). The application of aggregated databases also prevents nurses and health practitioners from overlooking important information. Thus, all crucial factors are taken into consideration when locating social determinants of health or building the program that is expected to address a specific health crisis.

Using large aggregated data also implies being able to infer important information about large communities and the threats that they face. Moreover, one can introduce financial, political, and economic variables to the analysis of the specified type of information to determine the ways of improving public health. For instance, the effects of ACA on the needs of people with a lack of access to healthcare services can be conducted to elicit the strategies that can be used to manage the identified concern (Felkey & Fox, 2015). The proposed techniques will lead to improvements in the creation of approaches for patient education and improvement of health literacy across the target community. Moreover, the application of the strategy will inform other decisions associated with the management of health issues, such as the medium that should be used to promote health literacy among community members. Specifically, it will be critical to define the role of social media in the identified scenario.

Provide an overview of the program evaluation model and health promotion theory you will use in your proposed community project. Explain your rationale for your choices?

Since the program in question implies adopting a comprehensive approach toward promoting education among nurses and patients, it will be sensible to utilize Benner’s model skill acquisition (Hutchinson, Higson, Cleary, & Jackson, 2016). By definition, the proposed technique implies encouraging active learning and promoting the rapid acquisition of relevant information (Bennett, Grimsley, & Rodd, 2017). Specifically, Benner’s model skill acquisition implies splitting the process of learning into five key stages (Novice, Advanced Beginner, Competent, Proficient, and Expert). The framework implies transferring from using observations to infer important information to relying on experience to deploying the analytical principle. However, unlike the rest of the stages, the final one also requires using a profound understanding of the subject matter to make decisions.

The use of the selected tool will help to determine the stage at which a nurse and a patient currently are, at the same time informing an educator about the strategies that can be utilized to enhance the learning process and address emerging difficulties. The model also provides a very clear and distinct typology of the stages of knowledge development, which makes the assessment process especially easy and insightful. By assigning each participant with a particular rating, one not only defines their progress but also creates the foundation for building further learning techniques. Herein lies the rationale for the choice; the model is flexible enough to be used in a multicultural setting and evaluate the progress of diverse populations. The application of the tool in question will allow improving the precision of the evaluation outcomes and determine the possibility of the proposed framework being deployed in other nursing settings. As a result, the program can be tailored to the needs of other populations and vulnerable groups, thus preventing the instances of epidemics and rise in mortality rates from occurring.

Provide an analysis of your surveyed community and what health-related community need is present. Define the methodology of the health improvement program you will use to solve this problem also include a timeline. Include any higher level of care management and policy decision that APNs who work in the community would need to be a partner with either community-based consortiums or health care policymakers.

To address the needs of a local community promptly and effectively, one needs to be fully aware of the health issues that are common in the identified setting, as well as socioeconomic and sociocultural factors affecting the lives of community members. In the target setting, low-income rates and poor health insurance make the process of receiving proper care extraordinarily difficult. Furthermore, the low level of education among the community members implies that they are most likely to dismiss the idea of health literacy as irrelevant and unneeded. Infrastructure issues are also likely to contribute to the development of health concerns. However, the fact that most of the community members are actively involved in social networks leaves the opportunity to advance their health knowledge by using modern social media.

The health improvement program will be based on the quantitative methodology since it is necessary to define the extent to which the participants’ health knowledge will have risen by the end of the process. The total population will amount to 1,000 participants, which means that the sample by which it will be represented in the study will equal 922 participants (Chow, ‎Shao, Wang, & Lokhnygina, 2017). The program will take four months to determine the extent to which the selected tool affects participants’ ability to gain new knowledge and skills. Higher levels of care will require individual consultations with patients to reduce the risk of them misinterpreting information or failing to acquire the needed skills (Leung, 2015). It could be argued that the application of the qualitative approach would help to shed more light on the way in which health literacy is perceived among the members of the designated community. However, at present, quantitative outcomes, particularly, the drop in health problems, are the focus of the program.

Complete the “Cultural Competence Self-Assessment Checklist” on the Central Vancouver Island Multicultural Society.

Discuss the knowledge gained and its implications for further personal growth and application in your practice.

In order to ensure a natural and uninhibited process of patient education, a nurse should be ready to meet rather rigid criteria for personal and professional growth. The Cultural Competence Self-Assessment Checklist offered by the Central Vancouver Island Multicultural Society (n.d.) gives a chance to gain an insight into one’s ability to engage in the active learning process, at the same time encouraging the target population to build their skills and health literacy levels.

The outcomes of the self-assessment have shown that I need to work on my ability to reflect on personal stereotypes. In addition, it is desirable for me to develop the ability to determine biases that may affect the quality of care provided to patients. The specified issue gains particularly high significance when managing the issues observed within vulnerable communities (Purnell, 2016). For instance, if the side effects of biases are underestimated, the quality of care may be reduced significantly, followed by a steep rise in negative and even lethal outcomes (Purnell, 2016). Thus, as a DNP, I will need to focus on addressing health-related biases.

Nonetheless, the general assessment outcomes have shown that, as a DNP, I can make a positive change in a community. Due to the ability to establish a dialogue with the target population, I will implement the program aimed at increasing health literacy effectively. As a result, patients from all backgrounds will receive the opportunity to access the required healthcare services and build their health literacy levels. Furthermore, I will receive insightful information that will help me to improve my skills.

Evaluate the implications of individual culture on health literacy and the role of the DNP in providing opportunities to improve levels of knowledge. Why is this relevant to the DNP and population health?

The significance of an individual culture on health literacy is very high when addressing various health-related issues. For instance, the problem of stereotypes and misconceptions regarding modern healthcare is quite common in a range of cultures. Indeed, in healthcare, stereotypes often affect professional judgments negatively, hampering the process of locating a health concern and preventing nurses from meeting the needs of the target population properly. In the context of the specified concern, the role of a DNP includes researching health-related myths and misconceptions that are typical for a particular area, considering the origin and nature of the identified myths, and designing the framework for enhancing health literacy among the target population (Curley, & Vitale, 2015). Thus, the premises for delivering proper care are created.

The relevance of the specified issue to the DNP and population health is evident. Without a profound understanding of the cultural factors that affect a patient’s perception of health, their attitude toward their well-being, and their decision-making regarding health management options, no positive outcomes can occur. Thus, a nurse has to create a setting in which patients are inclined toward learning new information and developing healthy behaviors and habits (Tobiano, Bucknall, Marshall, Guinane, & Chaboyer, 2015). Moreover, it is recommended for a nurse to foster the concept of lifelong learning in regard to health management in patients. The specified process is reciprocal since nurses also acquire a substantial amount of facts about specific cultures and the means of addressing the needs of their representatives. Thus, the process of patient education will have profound effects on the target population.

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