NURS 6050 Discussion Presidential Agendas Essay

NURS 6050 Discussion Presidential Agendas

NURS 6050 Discussion Presidential Agendas

Rather than focus on the treatment of chronic disease, policies that influence population health tend to emphasize prevention and wellness; the reduction or elimination of waste and the eradication of health disparities based on race, ethnicity, language, income, gender, sexual orientation, disability and other factors. The reasoning is that good health belongs to the whole, not just an individual. (New York State Dept. of Health, n.d.)
Regardless of political affiliation, every citizen has a stake in healthcare policy decisions. Hence, it is little wonder why healthcare items become such high-profile components of presidential agendas. It is also little wonder why they become such hotly debated agenda items.
Consider a topic (mental health, HIV, opioid epidemic, pandemics, obesity, prescription drug prices, or many others) that rises to the presidential level. How did the current and previous presidents handle the problem? What would you do differently?
Reference:
New York State Department of Health. (n.d.). Making New York the healthiest state: Achieving the triple aim. Retrieved June 21, 2021 from https://www.health.ny.gov/events/population_health_summit/docs/what_is_population_health.pdf
To Prepare:
• Review the Resources and reflect on the importance of agenda setting.
• Consider how federal agendas promote healthcare issues and how these healthcare issues become agenda priorities.
NURS 6050 Discussion Presidential AgendasBy Day 3 of Week 1
Post your response to the discussion question: Consider a population health topic that rises to the presidential agenda level. How did two recent presidents handle the problem? What would you do differently?
By Day 6 of Week 1
Respond to at least two of your colleagues* on two different days by expanding on their response and providing an example that supports their explanation or respectfully challenging their explanation and providing an example.
*Note: Throughout this program, your fellow students are referred to as colleagues.
Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.
Pilar Turner
RE: Discussion – Week 1
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Policies, Problems, and Planning to Reach Rural Veterans
Suicide accounts for 8.3% of deaths among U.S. adults, and Veterans alone represent an unignorable 14.3% of these tragedies (Department of Veterans Affairs [VA], 2018). Consequently, death by suicide for the veteran patient population is 1.5 times the rate of non-veteran sufferers (VA, 2018). Our current and previous presidential administrations have contributed to the funding and development of veteran suicide research and interventions. Since the inception of the Veterans Access, Choice and Accountability Act (CHOICE Act) of 2014, veteran suicide data and research has enabled policy makers to focus on reaching veterans living in rural areas. Veterans living in rural areas account for nearly one fourth of the veteran population (VA,2018). Veterans living in rural areas have a 20%-22% greater risk of death by suicide in comparison to veterans living in urban areas. According to the Veterans Affairs Office of Rural Health, 4.7 million veterans return from active military careers to live in rural areas, only 2.5 million are enrolled to receive VA health care services, and far more than half of enrolled veterans living in rural areas have service-connected disabilities (VA.gov: Veterans Affairs 2016).
In 2014, President Barrack Obama and Senator John McCain III set the groundwork for veteran mental health care reform with the passage of the Veterans Access, Choice and Accountability Act (CHOICE Act) of 2014. With this act, veterans in rural areas had expanded options to receive care from non-VA providers with the VHA’s coordination and approval. The CHOICE Act also highlighted health care staffing disparities via staff shortage reports required by the VA Office of Inspector General, and the identification of the need to increase Graduate Medical Education (GME) residency positions in the mental health specialty.
The Choice Act was further amended in 2016 with the passing of the Jeff Miller and Richard Blumentha Veterans Heath Care and Benefits Improvement Act to further increase the number of GME residency positions over 10 years instead of five and extended the program to 2024 (Albanese et al., 2019). Despite the increase in GME residency positions and extensions of program funding, health care disparities in rural areas continued their negative trend. At this point, veteran advocates and policy makers identified the physician shortage gap in rural areas as a mission-critical priority for the VHA and began working towards the John S McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal System and Strengthening Integrated Outside Networks (MISSION) Act of 2018.
In June 2018, the Obama administrations groundwork for the MISSION Act paved the way for the Trump Administration to see it through to fruition. With the problem stream of rural access leading policy formation, the MISSION Act created interventions based on physician shortages that now determine location, specialty, and amount GME residency positions within outlined parameters. Essentially focus has shifted from interventions to bring veterans to health care providers (HCP), to interventions to bring HCP to veterans. These interventions include expanding VA Health Care Profession Scholarships (HPSP) to graduate education for nurse practitioners select, who are allowed to practice at their full scope of practice without physician supervision. These expansions will increase patient access to quality health care and improve staffing shortages in rural veteran communities (American Association of Colleges of Nursing [AACN], 2016). In addition to GME improvements, veterans now could seek medical assistance from non-VA facilities without penalty when in need.
Most recently, the Biden Administration passed the Sgt. Ketchum Rural Veterans Mental Health Act of 2021. This bill was created in honor of its name’s sake, Sergent Brandon Ketchum, in addition to many other sailors, marines, and soldiers who lost their battles with suicidal ideation in the face of limited access to care. Sgt. Ketchum was a 33-year-old Operation Iraqi Freedom Veteran who served in Iraq and Afghanistan struggled with post-traumatic stress disorder and substance abuse after returning home to a rural area in Iowa. In 2016 he presented to the Iowa City VA Hospital where he asked to be admitted before the psychiatrist determined inpatient care was not needed at the time. Brandon returned home and committed suicide that night. An investigation was completed and no HCP’s were found to be directly responsible for his death; however, quality patient education on suicidal ideation, risk factor ratings, and access to routine outpatient psychiatric mental health services or the lack there of could be at fault. Under this bill, rural veterans diagnosed with Schizophrenia, Schizoaffective Disorder, Bipolar Affective Disorder, Major Depression, PTSD, and any severe or chronic mental health condition will have access to Rural Access Network for Growth Enhancement (RANGE) programs (Veterans Health Administration, VA.gov: Veterans Affairs 2013). The RANGE program provides intensive case management to veterans with serious mental illness who are experiencing homelessness or who are at risk of experiencing homelessness with an emphasis on recovery. The Sgt. Ketchum Rural Veterans Mental Health Act of 2021 bill also requires the government to conduct a study and report on whether the VA has adequate resources to provide services to rural veterans whose lives depend on mental health care the is more intensive than traditional outpatient therapy (Monteith et al., 2020).
Unfortunately, VA healthcare reform is faced with similar challenges of establishing universal health care but on a smaller scale. Agendas, interest groups, insurance stakeholders, pharmaceutical suppliers, and access to care are all variables in creating policies that appear to be relentless barriers to healthcare reform; however, change is a process. The evolution of the CHOICE act to the Sgt. Ketchum Rural Veterans Mental Health Act of 2021 is promising. Findings from this living body of veteran health data and research will continue to shape policy improvement. I am hopeful that with each future bill and amendment passed, a new layer of protection will be provided to those who have sacrificed their lives to protect us.
References
Albanese, A. P., Bope, E. T., Sanders, K. M., & Bowman, M. (2019). The VA mission act of 2018: A potential game changer for rural GME expansion and Veteran health care. The Journal of Rural Health, 36(1), 133–136. https://doi.org/10.1111/jrh.12360
American Association of Colleges of Nursing. (2016, December 13). VA ruling on APRN practice: a breakthrough for veterans health care. Message posted on the American Association of Colleges of Nursing Listserv:web@aacn.nche.edu
Department of Veterans Affairs (2018b). VA National Suicide Data Report: 2005–2015. Retrieved from
https://www.mentalhealth.va.gov/ docs/data-sheets/OMHSP_National_Suicide_Da ta_Report_2005-2015_06-14-18_508-compliant.pdf
Monteith, L. L., Wendleton, L., Bahraini, N. H., Matarazzo, B. B., Brimner, G., & Mohatt, N. V. (2020). Together with veterans: Va national strategy alignment and lessons learned from community‐based suicide prevention for rural veterans. Suicide and Life-Threatening Behavior, 50(3), 588–600. https://doi.org/10.1111/sltb.12613
VA.gov: Veterans Affairs. RURAL VETERANS. (2016, January 19).
https://www.ruralhealth.va.gov/aboutus/ruralvets.asp.
Veterans Health Administration, D. U. S. for O. and M. (2013, May 8). VA.gov: Veterans Affairs. Enhanced RANGE Program. https://www.lexington.va.gov/services/Enhanced_RANGE_Program.asp.

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4 months ago
Faisal Aboul-enein Walden Instructor Manager
RE: Discussion – Week 1
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Excellent narrative, so how do you see this within the context of Social Determinants of Health?
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4 months ago
Pilar Turner
RE: Discussion – Week 1; Response 1
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Dr. A.E.,
Thank you for the question. I see this health care disparity as a priority within the context of social determinants of health because of its pervasive nature. According to the Health People 2030 objectives, social determinants of health (SDOH) are the dynamic qualities and characteristics of the environment an individual is born into, lives, learns, works, plays, worships, and ages. These environmental qualities and characteristics are considered social determinants because they will directly or indirectly determine or impact the health, functioning, risks, and quality-of-life outcomes of the people living within it (Office of Disease Prevention and Health Promotion, 2021). The Healthy People 2030 Framework identified the following five domains of SDOH: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context.
Shortages of mental health care providers and poor access to mental health care services, especially in rural areas, fit perfectly under the health care access and quality domain; however, these same disparities have direct and indirect impacts on the existing four domains as well. Most mental illness diagnosis and disorders include a variable of pathology impacting your quality of life, or the impairment of your perception that thereof. Thus, the psychiatric mental health patient population in general, including veterans, require a scaled-up version of services due to the vary nature of the pervasiveness of untreated mental conditions on all domains of health and functioning. Effective mental health treatment has the power to help an individual function at work (economic stability), encourage self-actualization and improvement (by harnessing access to education or investing in their children’s), and find purpose and belonging in a community (neighborhood and community context). I would say the mental health provider shortage and poor access to mental health care services in the rural veteran community is a good place to start developing interventions and policies that can be translated to a larger population of people in need.
References
Office of Disease Prevention and Health Promotion. (n.d.). Social determinants of health. Social
Determinants of Health- Healthy People 2030. https://health.gov/healthypeople/objectives- and-data/social-determinants-health.
Chisholm, D., Sweeny, K., Sheehan, P,. Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016). Scaling-
up treatment of depression and anxiety: A global return on investment analysis. The Lancet Psychiatry, 3(5), 415-424. https://doi.org/10.1016/s22150366(16)30024-4

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4 months ago
JOY PRYOR
RE: Discussion – Week 1
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Pilar,
Thank you for your post. Suicide continues to devastate the military community at an alarming rate. This nurse is personally aware of 5 deaths within this past year alone at the base we were stationed at. This can be attributed to the culture of the military when it comes to how a person who is suffering from mental illness is treated. I can speak firsthand to this as I have a very close friend that has been struggling with her mental health and when she hinted at it to her bosses she was made to feel as if her job was in jeopardy because heaven forbid military men and women are human and suffer mentally. Active-duty members are not allowed to seek mental health treatment from an outside provider, Tricare mandates that all active-duty members must receive a referral from their Primary Care Provider to receive mental health services (Military One Source , 2020). I would like to see a President change that requirement, as many military men and women do not seek treatment because they must go through their PCP and that goes on their permanent record. I believe mental health services should be covered without a referral.

Reference:
Military One Source . (2020, August 12). 7 Counseling Options for Service Members and Their Families. Retrieved from Military One Source : https://www.militaryonesource.mil/confidential-help/non-medical-counseling/military-and-family-life-counseling/7-counseling-options-for-service-members-and-their-families/

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4 months ago
Irikefe Ojevwe
RE: Discussion – Week 1
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Hello PILAR,
I do agree with you that the presidential agenda has been crucial in enactment of policies that have had a resounding impact on the general well-being of the American public. One of the key presidential agenda is the CHOICE Act of 2014 under the Obama administration (Ohl et al., 2018). Some of the salient features of this act include; improvement of access to care from non-VA providers, additional expansion of access to care and reviewing and expanding capacity and processes (Sayre et al., 2018). Under the Veterans Choice Act, there is the veteran’s choice fund and this was to be in operation for three years until the exhaustion of the fund. Moreover, the VA is mandated to develop a system of tracing and paying the claims for the care provided to the veterans by the non-veterans under the program or any other non-VA entities. This is meant to help the veterans in the rural areas to be able to access quality care a month them proper mental health guidance and assistance after years of war (Kaboli & Fihn, 2019).
References
Kaboli, P. J., & Fihn, S. D. (2019). Waiting for Care in Veterans Affairs Health Care Facilities and Elsewhere. JAMA Network Open, 2(1), e187079–e187079. https://doi.org/10.1001/jamanetworkopen.2018.7079
Ohl, M. E., Carrell, M., Thurman, A., Weg, M. V., Pharm, T. H., Mengeling, M., & Vaughan-Sarrazin, M. (2018). “Availability of healthcare providers for rural veterans eligible for purchased care under the veterans choice act.” BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3108-8
Sayre, G. G., Neely, E. L., Simons, C. E., Sulc, C. A., Au, D. H., & Michael Ho, P. (2018). Accessing Care Through the Veterans Choice Program: The Veteran Experience. Journal of General Internal Medicine, 33(10), 1714–1720. https://doi.org/10.1007/s11606-018-4574-8

NURS 6050 Discussion Presidential Agendas Essay

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