Discussion: Presidential Agendas NURS 6050

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Discussion: Presidential Agendas NURS 6050

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 that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently?

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.
By Day 3 of Week 1

Post your response to the discussion question: Consider a topic that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently?

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:[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.

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

Discussion Presidential Agendas NURS 6050

providing an example.

*Note: Throughout this program, your fellow students are referred to as colleagues.

Submission and Grading Information

Grading Criteria

Click here to ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Discussion: Presidential Agendas NURS 6050

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 and Respond by Day 6 of Week 1

To participate in this Discussion:

Week 1 Discussion

Module 1: Agenda Setting (Weeks 1-2)

Laureate Education (Producer). (2018). Meet the Experts: Pioneers in Policy [Video file]. Baltimore, MD: Author.

Laureate Education (Producer). (2018). The Policy Process [Video file]. Baltimore, MD: Author.

Learning Objectives

Students will:

Compare U.S. presidential agenda priorities
Evaluate ways that administrative agencies help address healthcare issues
Analyze how healthcare issues get on administrative agendas
Identify champions or sponsors of healthcare issues
Create fact sheets for communicating with policymakers or legislators
Justify the role of the nurse in agenda setting for healthcare issues
Due By
Assignment
Week 1, Days 1–2
Read/Watch/Listen to the Learning Resources.
Compose your initial Discussion post.
Week 1, Day 3
Post your initial discussion post.
Week 1, Days 4-5
Review peer Discussion posts.
Compose your peer Discussion responses.
Begin to compose your Assignment.
Week 1, Day 6
Post at least two peer Discussion responses on two different days (and not the same day as the initial post).
Continue to compose your final draft of your Assignment.
Week 1, Day 7
Wrap up Discussion.
Week 2, Day 1–6
Continue to compose your Assignment.
Week 2, Day 7
Deadline to submit your Assignment.

Learning Resources

Required Readings

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

Chapter 1, “Informing Public Policy: An Important Role for Registered Nurses” (pp. 11–13 only)
Chapter 2, “Agenda Setting: What Rises to a Policymaker’s Attention?” (pp. 17–36)
Chapter 10, “Overview: The Economics and Finance of Health Care” (pp. 171–180)
Chapter 12, “An Insider’s Guide to Engaging in Policy Activities”
“Creating a Fact Sheet” (pp. 217-221)

DeMarco, R., & Tufts, K. A. (2014). The mechanics of writing a policy brief. Nursing Outlook, 62(3), 219–224. doi:10.1016/j.outlook.2014.04.002

Kingdon, J.W. (2001). A model of agenda-setting with applications. Law Review M.S.U.-D.C.L., 2(331)

Lamb, G., Newhouse, R., Beverly, C., Toney, D. A., Cropley, S., Weaver, C. A., Kurtzman, E., … Peterson, C. (2015). Policy agenda for nurse-led care coordination. Nursing Outlook, 63(4), 521–530. doi:10.1016/j.outlook.2015.06.003.

O’Rourke, N. C., Crawford, S. L., Morris, N. S., & Pulcini, J. (2017). Political efficacy and participation of nurse practitioners. Policy, Politics, and Nursing Practice, 18(3), 135–148. doi:10.1177/1527154417728514

Institute of Medicine (US) Committee on Enhancing Environmental Health Content in Nursing Practice, Pope, A. M., Snyder, M. A., & Mood, L. H. (Eds.). (n.d.). Nursing health, & environment: Strengthening the relationship to improve the public’s health.

USA.gov. (n.d.). A-Z index of U.S. government departments and agencies. Retrieved September 20, 2018, from https://www.usa.gov/federal-agencies/a

USA.gov. (n.d.). Executive departments. Retrieved September 20, 2018, from https://www.usa.gov/executive-departments

The White House. (n.d.). The cabinet. Retrieved September 20, 2018, from https://www.whitehouse.gov/the-trump-administration/the-cabinet/

Document: Agenda Comparison Grid Template (Word document)

RE: Discussion – Week 1

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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.

RE: Discussion – Week 1

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Week 1 Discussion: Response 1Hello Benjamin! 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 Detail

Select Grid View or List View to change the rubric’s layout.
Content
Name: NURS_6050_Module01_Week01_Discussion_Rubric

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List View

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

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

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Discussion: Presidential Agendas NURS 6050

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