Discussion: Presidential Agendas NURS 6050

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.

Discussion: Presidential Agendas NURS 6050

A new piece of legislation, the Jeff Miller and Richard Blumentha Veterans Health Care and Benefits Improvement Act, was passed in 2016, which increased the number of GME residency seats from five to ten while also extending the program through 2024, as originally intended (Albanese et al., 2019). Despite the expansion of GME residency positions and budget extensions, rural health care inequities continued to worsen. There is a physician shortage gap in rural areas, which is a mission-critical priority for the Veterans Health Administration (VHA). Advocates and policymakers started working towards the John S McCain III (Daniel K Akaka) VA Maintaining Internal System and Strengthening Integrated Outside Networks Act of 2018 (MISSION).

Discussion: Presidential Agendas NURS 6050

In June 2018, the Obama administration laid the framework for the Trump Administration’s MISSION Act, paving the path for it to become a reality. Mission Act actions based on physician shortages now influence GME residency locations, specialties, and the number of positions available within stated constraints. The focus has switched from bringing veterans to health care providers (HCP) to bringing health care providers to veterans. In addition, these measures include expanding the VA Health Care Profession Scholarships (HPSP) to graduate studies for nurse practitioners who are allowed to practice without physician supervision. Expansions such as these will alleviate staffing shortages in remote veteran communities while also improving patient access to high-quality health care (American Association of Colleges of Nursing [AACN], 2016). Non-VA facilities can now help vets in need without fear of repercussion thanks to GME changes.

The Sgt. Ketchum Rural Veterans Mental Health Act of 2021 was recently passed by the Biden Administration. Many sailors, marines, and soldiers have lost their lives due to a lack of access to treatment for suicide thoughts, so this law is dedicated to Sergent Brandon Ketchum. Military veteran Sgt. Ketchum had post traumatic stress disorder and substance misuse issues when he returned home to rural Iowa after serving in Iraq and Afghanistan. At the Iowa City VA Hospital in 2016, he requested to be admitted, but the psychiatrist ruled that inpatient care was not required at the time. Brandon went back to his house and died that night by suicide. Although no health care professionals were determined to be directly responsible for his death, quality patient education on suicidal ideation, risk factor ratings and access to routine outpatient psychiatric mental health services or the lack of these could be to blame. RANGE (Rural Access Network for Growth Enhancement) programs will be available to rural veterans who have been diagnosed with schizophrenia, schizoaffective disorder, bipolar affective disorder, major depression, PTSD, or any other severe or persistent mental health illness (Veterans Health Administration, VA.gov: Veterans Affairs 2013). Veterans with major mental illness who are homeless or at danger of homelessness can receive intense case management through the RANGE program, which focuses on recovery. Rural veterans who require more rigorous mental health treatment than typical outpatient therapy are entitled to a study and report under the Sgt. Ketchum Rural Veterans Mental Health Act of 2021, which mandates that the government do so (Monteith et al., 2020).

Although on a smaller scale, VA healthcare reform faces similar obstacles to achieving universal coverage. There are a number of factors that contribute to the creation of policies that appear to be insurmountable obstacles to healthcare reform. However, change is a process. The Sgt. Ketchum Rural Veterans Mental Health Act of 2021, which will replace the CHOICE Act, is a hopeful step forward. Policymakers will use the findings from this ongoing amount of data and study on veteran health. We owe those who have given their lives to defend us an extra layer of protection with each new bill and amendment that is passed.

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:[email protected]

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.

Discussion: Presidential Agendas NURS 6050

            Agenda setting is the process where special interest groups or lobbyist set their problem to government attention (Milstread & Short 2019). In nursing, we have seen a rising plague that leaves patients and families broken and mourning, I am speaking of opioid addiction. Nurses and other interprofessional healthcare workers have taken this systemic agenda and propelled it through the institutional agenda to a decision agenda (Milstread & Short 2019). The current and past Presidents of the United States have acknowledged this agenda and have attempted to curtail this growing epidemic of opioid abuse.

President George W Bush said on his first national address that illegal drugs were the gravest domestic threat (Weedon, 2002). Continuing President Bush said that drugs were an  “Individual tragedy, And, as a result, a social crisis.” (state.gov). Identify the problem came from lobbyists bringing it up the channels and making it a forefront issue. President Bush created at $19 Billion dollars congressional budget to fight drug addiction with the goals to limit the drug supply and reduce the demand. Funding for reducing demand went to public education forums, drug addiction in schools. The goals set by President Bush and his administrative team was to see a “10 percent reduction in teenage and adult drug use over the next two years, and a 25 percent reduction in drug use, nationally, over the next five years.” (state.gov).

President Obama followed President Bush and the opioid crisis continued to ravage the nation. The rate of opioid-related overdose deaths increased more than 200% within the 15 years (Abraham et, al 2017). One of the greatest counter attacks to the opioid crisis was the formation and enactment of the Affordable Care Act. Among other benefits of the Affordable Care Act was the empowerment of the individual states to take action on the opioid crisis. Another great benefit of this legislature was the ability of patients to access substance abuse disorder treatments such as outpatient treatment, residential treatment programs, detoxification, recovery support services, and assistive medications (Abraham et, al 2017). It is estimated 1.6 million Americans with substance abuse disorder gained insurance and access to health care related to the Affordable Care Act (Abraham et, al 2019).

Following President Obama President Trump continued the fight on opioids. President Trump declared opioid addiction a public health emergency (Thompson, 2019).  President Trump signed into law October 24^th 2018, SUPPORT for Patients and Communities Act. This bipartisan bill was introduced June 3, 2018, and was negotiated and finalized October 3, 2018 (Thompson 2019). Within the confines of this legislature was the Medicaid patient access to substance abuse disorder medications such as but not limited to buprenorphine and naltrexone. Additionally, physicians are now required to include opioid addiction in documenting patient histories (Thompson 2019.)

All three Presidents have contributed to the ongoing domestic war of opioid addiction and substance abuse disorders. The legislation is only as effective as the lobbyist that propel them through the levels of political agenda (Milstread & Short 2019). I would like to see all insurance Medicaid or commercial to work more transparently with physicians and local health officials to have a more transparent screening of the number of opioids being prescribed. I agree with harsher criminal sentencing for illegal drug manufacturing and sale. I would like to see more public education on signs of addiction and greater access to community resources, especially in more rural America.  I believe all three Presidents had great success in identifying and combating this crisis. We as nurses must continue to agenda-setting with our representatives to see the continual change in this arena.

References:

Abraham, A. J., Andrews, C. M., Grogan, C. M., Pollack, H. A., D, A. T., Humphreys, K. N., & Friedmann, P. D. (2017). The Affordable Care Act Transformation of Substance Use Disorder Treatment. American Journal of Public Health, 107(1), 31–32. https://doi-org.ezp.waldenulibrary.org/10.2105/AJPH.2016.303558

Milstead, J. A., & Short, N. M. (2019). Health Policy and Politics a nurses Guide   (6th ed.). Burlington, MA: Jones & Bartlett Learning.

President Bush Announces Drug Control Strategy. (2002, February 12). Retrieved           September 01, 2020, from https://2001-2009.state.gov/p/inl/rls/rm/8451.htm

Thompson, C. A. (2019). Trump signs legislation to combat opioid crisis. American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, 76(1), 5. https://doi-org.ezp.waldenulibrary.org/10.1093/ajhp/zxy028

Weedon, J. R. (2002). Drug war undergoes reform. (Legislative Issues).   Corrections Today, 5, 24.

Discussion: Presidential Agendas NURS 6050

RE: Discussion – Week 1

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Week 1 Discussion: Response 1

I like that you touched on wanting to bring more addiction resources to rural areas of America. I currently work on a drug and alcohol detox unit at a hospital that serves several rural counties in North Carolina. What are some ideas you have to help rural communities that deal with addiction? Carr & Stewart (2019) found that school nurses in rural areas have the opportunity to identify or address risk factors that could lead to addiction (p.23). School nurses are uniquely positioned to not only educate students about mental health but also their families, which can trickle out into the community as a whole. Another major hurdle to serving the rural population would be the stigma behind asking for help with mental health issues or addiction. Young & Rabiner (2015) found that parents in rural areas were quicker to ask for help for a physical illness rather than mental health issues due to the stigma that behavioral problems or mental issues reflected poorly on parenting styles.ReferencesCarr, K. L., & Stewart, M. W. (2019). Effectiveness of school-based health center delivery of a cognitive skills building intervention in young, rural adolescents: Potential applications for addiction and mood. Journal of Pediatric Nursing, 47, 23–29. https://doi.org/10.1016/j.pedn.2019.04.013Young, A. S., & Rabiner, D. (2015). Racial/ethnic differences in parent-reported barriers to accessing children’s health services. Psychological Services, 12(3), 267–273. Retrieved September 3, 2020, from https://doi.org/10.1037/a0038701Rubric DetailSelect Grid View or List View to change the rubric’s layout.
Content
Name: NURS_6050_Module01_Week01_Discussion_RubricGrid View
List ViewExcellent Good Fair Poor
Main Posting
Points Range: 45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.Supported by at least three current, credible sources.Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.Points Range: 40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 35 (35%) – 39 (39%)
Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range: 0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
Points Range: 10 (10%) – 10 (10%)
Posts main post by day 3.

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)
Does not post by day 3.
First Response
Points Range: 17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.

Points Range: 15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 13 (13%) – 14 (14%)
Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Second Response
Points Range: 16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.

Points Range: 14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 12 (12%) – 13 (13%)
Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
Name: NURS_6050_Module01_Week01_Discussion_Rubric

Discussion: Presidential Agendas NURS 6050

RE: Discussion – Week 1

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 While it is an extraordinarily broad topic, national healthcare and the reform thereof is always a topic at the forefront of the political arena.  Every president has a hand in the maintaining or changing the vast matter that is our national healthcare.  Below I will briefly discuss some of the more familiar changes and implementations of the last three United States presidents and quickly discuss how each of them handled the issues.

Former president George Bush made several reforms to healthcare during his terms in the White House; among the most notable was the prescription drug benefit.  According to The White House archives, President Bush’s prescription drug benefit plan “provided more than 40 million Americans with better access to prescription drugs” (The White House, n.d., The Bush Record).  This website also tells us that under Bush there were preventative screening programs added to the Medicare plans to assist with and improve preventative care.  The archives also state that “Increased competition and choices by stabilizing and expanding private plan options through the Medicare Advantage program, and increased enrollment to nearly 10 million Americans.  Increased private plan enrollment from 4.7 million in 2003 to nearly 10 million in 2008 (more than 20 percent of all Medicare beneficiaries).  The Administration also ensured nearly every county in America has a private plan choice, many with zero dollar premiums and supplemental benefits” (The White House, n.d., The Bush Record).

Healthcare reform was one of the Barack Obama administration’s key issues.  It was the dream of this administration to make affordable and quality health care the right of every citizen.  The reform preposed was a massive overhaul of what was in place.  For the sake of brevity, I will discuss only a few of the ideals implemented.  According to The White House archives, there was an expansion of discount and rebate programs to reduce drug costs. (The White House, n.d., Improving Health for Americans).  Another point of this massive overhaul was “Ensured individual and small business health plans include essential health benefits, covering emergency services, hospitalization, maternity and newborn care, preventive care such as annual physicals, and more” (The White House, n.d., Improving Health for Americans).

The Trump administration’s attention on national healthcare has been much more focused.  The White House website offers that “President Trump has taken decisive action to lower drug prices for American patients, resulting in declines after years of rising prices” (The White House, 2020, The Fact Sheet).  This includes approving several generic drugs, and a plan to allow importation of drugs from Canada.  This si

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