N444 Quiz 1

Healthy People 2030: An Example of National Health Policy Guidance

-Attaining healthy, thriving lives and well-being, free of preventable disease, disability, injury and premature death. -Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all. -Creating social, physical, and economical environments that promote attaining full health and well-being for all. -Promote healthy development, healthy behaviors, and well-being across all life stages. -Healthy People 2030 is an example of National Health Policy Guidance; it Builds on Healthy People 2000, 2010, 2030 -There are four overarching goals-see slide, also...engage leadership, key constituents and the public across multiple sectors to take action and design policies that improve the health and well-being of all. -Best resource that provides a broad vision of the goals and objectives of many health care stakeholders in our nation and identifies the current national health policy for the United States.

Federal Non-health Agencies

-Department of Defense -Department of Labor -Department of Agriculture -Department of Justice

Federal IT Plan 2022-2025

Promote Health and Wellness Enhance the Delivery and Experience of Care Build a Secure, Data-Driven Culture to Accelerate Research and Innovation Connect Healthcare and Health Data through an Interoperable Health IT Infrastructure

Federal Health Principles

Put individuals first Focus on value Build a culture of secure access to health information Put research into action Encourage innovation and competition Be a responsible steward

regulations

Regulations are specific statements of law related to defining or implanting individual pieces of legislation or statute law. For example, state legislatures enact laws (statutes) establishing boards of nursing and defining terms, such as registered nurse and nursing practice. Every state has a board of nursing. The board may be found either in the department of licensing boards of the health department or in an administrative agency of the governor's office. Created by legislation known as a state nurse practice act, the board of nursing is made up of nurses and consumers.

Technologies

Robots 3 D printing Artificial pancreas Smart pills SMART Homes Gene Editing

Device Integration and Alarms

SMART Pumps Call lights Smart Beds Cardiac monitoring systems EICU

Laws Specific to Nursing Practice

Scope of Practice Professional Negligence

legislative branch

Senate and House of Representatives

judicial branch

System of federal, state, and local courts guided by opinions of the Supreme Court

The Process of Regulation

advisory groups; special task forces; nurses' means of influence (writing letters, speaking at public hearings, attending hearings, testifying, and lobbying)

information

all branches and levels of government collect, analyze, and disseminate data about health care and health status of the citizens (example: annual report Health: United States)

public policy

all governmental activities, direct or indirect, that influence the lives of all citizens

police power

allows states to act to protect the health, safety, and welfare of their citizens; such police power must be used fairly, and the state must show that it has a compelling interest in taking actions, especially actions that might infringe on individual rights; an example of police power is requiring immunization of children for entry to school

professional negligence (malpractice)

an act (or a failure to act) that leads to injury of a patient

vision

an inspirational and futuristic belief/perspective of what the organization wants to achieve

major attributes

authorized governmental institutions make the decisions; the decision-making process is subject to public review and input; health policies address public policy goals

palliative care

available while patient is still receiving life prolonged or life saving therapies; begins much earlier in the disease trajectory; disease treating professionals continue consulting services

self management

behaviors and activities an individual employs for the practical management of an illness, such as taking medications and managing physical or functional effects of the illness

WHO and nurses

besides offering direct health services in every country in the world, nurses serve as consultants, educators, and program planners and evaluators; nurses focus their work on a variety of public health issues, including the health care workforce and education, environment, sanitation, infectious diseases, wellness promotion, maternal and child health, and primary care

how is advocacy accomplished?

by building relationships with the appropriate policy makers—the individuals or groups that determine a specific course of action to be followed by a government or institution to achieve a desired end (policy outcome); relationships for effective advocacy can be built in a number of ways

Impact of government health functions and structures on nursing

categorical funding, Pandemic and All-Hazards Preparedness Act (PAHPA)

policy setting

chief governmental function; governments at all levels and within all branches make policy decisions about health care

Private Nonprofit (Not-for-Profit)

controlled by voluntary boards or trustees; provide care to a mix of paying and non paying patients; obligation to provide services regardless of ability to pay; tax exempt status must serve community; excess revenue over expenses is redirected into the organization for maintenance and growth

informal-spoken word

day to day lived experiences of both staff and patients

health policy review

defined as a set course of action to obtain a desired health outcome, either for individuals, families, groups, communities or societies; process of turning health problems into workable solutions; policy process is very similar to the nursing process; relationship between nursing practice, health policy and politics can best be described as nursing advocacy

department of defense

delivers healthcare to members of the military

constitutional law

derives from federal and state constitutions; provides overall guidance for selected practice situations; police power of the states

Categorical Funding

designation of money for specific needs; led to narrowly focused nursing roles (examples emergency preparedness, school nursing)

personal power strategies

development of personal strategies or tools important; used when developing professional power; powerful image vital

policy formulation

different ideas are proposed and considered

government health care functions

direct services, financing, information, policy setting, public protection

forces influencing healthcare organizations

economic factors, social factors, demographic factors

Pandemic and All-Hazards Preparedness Act (PAHPA)

enacted in 2006 to improve the nation's ability to detect, prepare for, and respond to a variety of public health emergencies; goal to improve the organization, direction and utility of preparedness efforts

participative governance

federal, state, and local governmental power is gained through elected representation; citizens have indirect power to develop or change policy through the election process; involved citizenry leads to healthy, participative governance

direct services

federal, state, and local governments provide direct health services to certain individuals and groups

purpose of primary care

first access care; healthcare management of common and chronic illnesses; healthcare coordination/maintenance

state and police power to act through its health system

first, it must be a "reasonable" exercise of power; second, if the power interferes or infringes on individual rights, the state must demonstrate that there is a "compelling state interest" in exercising its power.

organizational culture or climate culture

formal-written word; informal-spoken word

connection power

gained by association with powerful individuals - take advantage of opportunity to have conversations with Managers, Directors, CNO

health policy

goal-directed decision-making about health that is the result of an authorized, public decision-making process OR a set course of action to obtain a desired health outcome for an individual, family, group, community, or society

financing

governments pay for some health care services and for some training of some health personnel and for biomedical and health care research; current percent of the health care services bill paid by the government is about 45.3%, and this increased to 47.6% by 2015

Self-management and nursing care

health enhancement and wellness; pre-disease and/or disease prevention; disease and/or new diagnosis; acute event management

minor attributes

health policies are subject to ongoing review; health policy goals change

department of justice

health services to federal prisoners are administered with this department

department of agriculture

houses Food and Nutrition Service

department of labor

houses OSHA

legislation

law that comes from the legislative branches of federal, state, or local government; this is referred to as statute law because it becomes coded in the statutes of a government

methods of building relationships for advocacy

letter or visits to lawmakers; contributions of money; contributions of labor, expertise, or influence; grassroots network development

formal-written word

mission, vision, values/philosophy, job description, policies/procedures

social factors

more focus on health/wellness over illness; customized care plans desired by more individuals

what does the executive branch do?

suggests, administers, and regulates policy

public protection

the U.S. Constitution gives the federal government the authority to provide for the protection of the public's health; this function is carried out in numerous venues, such as by regulating air and water quality and protecting the borders from the influx of diseases by controlling food, drugs, and animal transportation, to name a few

politics

the art of influencing others to accept a specific course of action; therefore, political activities are used to arrive at a course of action (the policy)

philosophy

the concepts and principles of the organization related to the rights of individuals, health, and nursing; the expectations of practitioners; and commitment of the organization to professionalism, education, evaluation, and research

public health policies

the creation of public health policy is a responsibility of the government and is a means for protecting the public; policy is goal oriented, public, and authoritative nature

values

the priorities of the organization culture including an emotional investment

what does health policy include?

those actions, non-actions, directions, and/or guidance related to health that are decided by governments or other authorized entities

hospice

those in hospice always receive palliative care, but hospice focuses on a person's final months of life (6 months or less); team oriented approach to enhance comfort and improve quality of life with such therapies as symptom management, emotional, spiritual and bereavement support for the patient and families

examples of primary care

-Ambulatory care -Provider office (MD, DNP, PA, some specialties) -PPO/HMO -Community/Neighborhood clinic -School and Occupational Health offices

misison

What do we do today? Who do we serve? What are we trying to accomplish? What impact do we want to achieve?

values

What do we stand for? What behaviors do we value over all else? How will we conduct our activities to achieve our mission and vision? How do we treat members of our own organization and community?

vision

Where are we going moving forward? What do we want to achieve in the future? What kind of future society do we envision?

B

Which group proposes, debates, passes, and modifies laws to address problems? A. Executive branch B. Legislative branch C. Judicial branch D. Police power

dynamic tension

a dynamic tension exists with access to health care, health care cost, and health care quality; changing one of these variables can improve or lessen the effectiveness of another; therefore, a dynamic tension exists with access to health care, health care cost, and health care quality; changing one of these variables can improve or lessen the effectiveness of another

agenda setting

a health-related issue is identified as a problem; nurses can be especially effective in this stage by helping to frame the issue (for example, assisted suicide may be ethically justified because patients have the right to make their own decisions - in this case, a controversial issues Is framed as an ethical concern)

Healthcare organization

a purposefully designed, structured social system developed for the delivery of health care services by specialized workforces to defined communities, populations or markets

policy

a set course of action to be followed by a government or institution to obtain a desired end

law

a system of privileges and processes by which people solve problems based on a set of established rules; it is intended to minimize the use of force

information power

access to and control over important information; a knowledgeable, experienced nurse is sought out to help teach your patient

The IOM Future of Nursing Report

-Acting now to improve the health and well-being of the nation -Lifting barriers to expand the contributions of nursing -Designing better payment models -Strengthening nursing education -Valuing community and public health nursing -Fostering nurses' roles as leaders and advocates -Preparing nurses to respond to disasters -Supporting the health and well-being of nurses

Intended Outcomes of Palliative Care

-Advanced Care Planning -Increased coping -Increased quality of life -Relief from suffering and symptoms -Enhancement of human dignity (home death if possible) -Effective closure -Improved bereavement outcomes -Healing of relationships -Decreased gait -Decreased psychological distress -Improved coping

WHO palliative care definition

-Affirms life and regards death as a normal process. -Does not hasten or postpone death. -Provides relief from pain and other symptoms. -Offers a support system to help patients live as actively as possible right up to their death. -Integrates psychological and spiritual care. -Provides a wider support to help the family cope during the patient's illness and their own bereavement after death

Federal Health Agencies

-Federal Health Agencies -U.S. Department of Health and -Human Services -Health Resources and Services Administration -Centers for Disease Control and Prevention -National Institutes of Health -Agency for Healthcare Research and Quality -Centers for Medicare and Medicaid Services

intergovernmental relationships

-Health policy can be made at the federal level, state level, or local level. -Many policy initiatives require collaboration between the federal government and the state government. -These relationships result in complex shared responsibilities and, at times, challenges in establishing authority. -The US constitution provides for division of power between the federal government and states, seeking balance, one against the other. The result is limited government powers that create the need for collaboration through systems of intergovernmental relationships.

examples of tertiary care

-Home health -Rehab center -Skilled nursing/Assisted living or long-term care (beyond 30 days)

Competencies for Nurses Tiger and QSEN

-Identify essential information in a common database -Navigate-Document-Plan care in EHR -Employ communication technologies to coordinate care -Protect confidentiality of PHI -Respond appropriately to Clinical -Data Support tools and alerts -Use information management tools to monitor outcomes of care processes -Use high quality electronic sources of healthcare information

attributions of palliative care

-Individualized patient care -Support for the family -Interdisciplinary teamwork -Trust -Safety -Effective communication

quality goals/outcomes examples

-Patient-Caregiver experience (i.e., HCAPS) -Care Coordination (i.e., 30-day readmission rate) -Preventative Health (i.e., Influenza vaccine) -At-risk population health (i.e., HTN, Hgb A1c, Depression readmissions)

Core Competencies Informatics Leaders

-Promotes quality of care and patient safety through oversight of the design and training of work processes using IT. -Accountable for the development and oversight of functional teams creating integrated clinical solutions for end users. -Demonstrates a good understanding of both the operational world of healthcare delivery and the technical world of HCIT. Serves as a liaison between IT and clinical leadership at the executive level. -Guides the design and oversees the implementation and management of the structure and strategies that support end-users' use of information technology for safe, quality patient care.

ownership structure

-Public institutions -Private nonprofit -For profit -Accountable Care Organization (ACO)

Need for EHR Improvements

-Reduce the documentation burden. Some are targeting a 50% reduction in documentation time -Improve clinical effectiveness -Increase professional satisfaction and reduce clinician burnout -EHRs are intended to improve access to healthcare data, and most do offer this advantage by making information digitally available and searchable

examples of secondary care

-Specialty care clinic -Ambulatory care centers -Acute care hospital (less than 30 days) -Home health

To recover money damages in a malpractice action, the patient must prove...

-That the nurse owed a duty to the patient or was responsible for the patient's care -That the duty to act the way a reasonable, prudent nurse would act in the same circumstances was not fulfilled -That the failure to act reasonably under the circumstances led to the alleged injuries -That the injuries provided the basis for a monetary claim from the nurse as compensation for the injury

World Health Organization (WHO)

-WHO office in U.S. is Pan American Health Organization (PAHO) -World Health Assembly (WHA)-WHO's policy making body WHO policy statements are guides for in-country initiatives and priorities -WHO office for the Americas is located in Washington, DC, and is know as the Pan American Health Organization (PAHO). -World Health Assembly (WHA) is WHO's policy-making body.

Health Equity: Societal Factors Influencing Health

-We know social determinants of health have a bigger impact on a person's health than clinical care. Therefore, we must support practices that address these key issues as part of a successful population health strategy. -Food insecurity increases people's risk for chronic disease and mental illness. There is an increased number of people experiencing food insecurity during the pandemic. -In 2019, 10.9% of the population experienced food insecurity. In 2021, it is projected that 12.9% will experience food insecurity. -Regarding children, the percent jumped from 14.6% in 2019 to 17.9% in 2021. -Severe maternal morbidity measures unexpected outcomes from labor and delivery with significant short- or long-term consequences to a woman's health. Disparities in severe maternal morbidity are more pronounced for women in majority Black or Hispanic communities when compared to majority white communities. Many factors, including one's environment, contribute to these disparities. For instance: -Compared to white mothers, mothers of color say they were not always able to complete the recommended series of prenatal visits, mainly because of lack of transportation or scheduling conflicts. -The AHA provides resources to help hospitals address social determinants of health and supports the Better Health for Mothers and Babies initiative. -Food Insecurity -Rates of Severe Maternal Morbidity --> Increased by 9% for all women from 2018 to 2020. --> 63% higher in majority Black communities than majority White communities in 2020. --> 32% higher in majority Hispanic communities than majority White communities in 2020

Trends in informatics/health technology

Care Everywhere Telehealth is now mainstream Wearables and Personalized Care Virtual reality is finding practical use cases for everything from improving clinical training to patient rehabilitation. Predictive Analytics and Big Data

Future of Nursing Report 2021

1. All national nursing organizations should initiate work to develop a shared agenda for addressing social determinants of health (SDH) and achieving health equity (HE). 2. By 2023, state and federal government agencies, health care and public health organizations, payers and foundations should initiate substantive actions to enable the nursing workforce to address the above. 3. By 2021, nursing education programs, employers, nursing leaders, licensing boards, and nursing organizations should initiate the implementation of systems to promote nurses' health and well-being. 4. All nurses to practice to the full extent of their education and training by removing barriers. 5. Flexible payment mechanisms to support nurses in addressing social needs, SDH, and HE. 6. Incorporate nursing expertise to support initiatives focused on SDH and HE. 7. Nursing education programs should ensure that nurses are prepared to address SDH and HE. 8. Strengthen and protect the nursing workforce during the response to public health emergencies and natural disasters. 9. All national health programs come together to develop and support a research agenda describing the impact of nursing interventions, including multi sector collaboration on SDH, environmental health, HE, and nurses' health and well-being.

Triple Aim of Improving U.S. Healthcare

1. Improving the experience of care 2. Improving the health of populations 3. Reducing per capita costs of health care

Five Key Attributes of Self-Management

1. Self efficacy 2. Patient engagement 3. Health education 4. Patient-provider relationship 5. Disease management

empowerment

1. Used in nursing related to administration and management 2. Authority or power given to someone to do something or process of becoming stronger 3. Consistent with contemporary view of leadership

trends of use of EMR

Individual data to population management Social determinants of health - community/social resources Patient portals Virtual visits - home monitoring Health coaching with proactive engagement Home diagnostics/smart homes

Nurse Identifier

A unique nurse identifier (UNI), a defined code or series of characters, represents an individual nurse within healthcare technology systems and across healthcare organizations. UNIs can help quantify nursing-sensitive outcomes and increase the evidence of their contributions to patient care. NCLEX ID?

Innovation and Delivery Transformation: Evolving Care Models

Accountable Care Organizations Organizations participating in value-based payment arrangements during the pandemic had greater financial resilience and flexibility to provide care through novel approaches. They had developed organizational competencies they could redeploy during a public health emergency. Hospital-at-Home (HaH) Expansion Health care strategists were asked about their likelihood of incorporating HaH services by 2027 for at least 50% of stable, chronically ill patients The nation's health care system is undergoing dramatic change as the country shifts to a value-based business model. Value-based care models center on patient outcomes and quality of care, as opposed to fee-for-service models that reimburse based on the quantity of services provided. Hospitals and health systems must examine their own unique situations and communities as they consider the movement to value-based care models. Accountable care organizations (ACOs) are one such example of value-based care. ACOs experienced rapid growth from 2010 to 2018. The ACO model plateaued by 2018 in terms of number of participating organizations, but value-based payment activity may be increasing in other areas such as direct contracting and advanced primary care models.1 Organizations participating in value-based payment arrangements during the pandemic had greater financial resilience and flexibility to provide care through novel approaches. They had developed organizational competencies they could redeploy during a public health emergency. The pandemic and associated public health emergency amplified the need for providers to increase capacity to provide safe care outside the hospital setting. Another innovative care model is Hospital-at-Home, which provides hospital-level care in a patient's home as a substitute for acute hospital care. Various studies have shown that Hospital-at-Home is feasible, safe, highly satisfactory and cost-effective. Over half of surveyed healthcare strategists believe that by 2027, their hospitals will have incorporated Hospital-at-Home for at least 50% of their stable, chronically ill patients.

process of policy development

Agenda setting → Policy formulation → Policy adoption → Policy implementation → Policy evaluation

informatics

Clinical Informatics promotes understanding, integration, and application of information technology in healthcare settings. It ensures adequate support of clinician objectives and industry best practice; integrates clinical science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom to optimize healthcare delivery and improve outcomes (HIMSS)

Hospital and Health System Landscape

COVID-19 continues to take a heavy toll on America's health care infrastructure. After historic financial losses in 2020, the 2021 net income loss estimate for hospitals and health systems is $54 billion. If the federal government had not provided relief funds, losses in net income could be as high as $92 billion. Patient volumes increased in 2021, but are still lower than pre-pandemic levels. Higher costs of caring for sicker patients combined with fewer outpatient visits could lead median hospital margins to be 11% below pre-pandemic levels by year's end. More than a third of hospitals are expected to end 2021 with negative operating margins. Workforce shortages have worsened and labor costs have skyrocketed. Hospitals and health systems are paying $24 billion more per year for qualified clinical labor than they did pre-pandemic. Travel nurse rates jumped more than 200%. Hospitals are spending approximately 62.5% more for travel RNs than they did at the start of 2020. $54 billion: Projected net income losses to hospitals and health systems in 2021. More than a third of hospitals are expected to end 2021 with negative operating margins. Hospitals and health systems are paying $24 billion more per year for qualified clinical labor than they did pre-pandemic. Travel nurse rates jumped over 200%. Hospitals are spending approximately 62.5% more for travel RNs than they did at the start of 2020.

AHA 2022 Environmental Scan

COVID-19 has had a profound impact on all of the topics in the 2022 Environmental Scan, which include: -The hospital and health system landscape -Co-existing with COVID-19 -Workforce -Health equity -Behavioral health -Access and affordability -Innovation and delivery transformation Hospital and Health System Landscape: Financial challenges, volumes and utilization and supply chain Co-existing with COVID-19: COVID-19 infection and after-effects, hospitalization, vaccination, life expectancy and cost Workforce: Resiliency, shortages, employment trends, future of work Health Equity: COVID-19 disparities, digital health equity, rural health, social determinants of health and maternal health Behavioral Health: The pandemic's impact on mental health and substance misuse Access and Affordability: Coverage and affordability to the consumer Innovation and Delivery Transformation: Telehealth, technology and delivery and payment models

Public Health Security and Bioterrorism Preparedness and Response Act (2002)

Created to implement the following ant bioterrorism activities: improving public health capacity, upgrading of health professionals' ability to recognize and treat diseases caused by bioterrorism, speeding the development of new vaccines and other countermeasures, improving water and food supply protection, tracking and regulating

Public Health Threats and Emergencies Act (2000)

First federal law to address preparedness for bioterrorism and outbreaks

public institutions

Funded and accountable to a government agency; Federal (VA), State (Public Health Department), Local (County and City Facilities)

what does the legislative branch do?

Identifies problems and proposes, debates, passes, and modifies laws to address those problems

Health Equity

Health equity is when all members of society enjoy a fair and just opportunity to be as healthy as possible Additionally, job losses have disproportionately affected communities of color, women, younger workers and workers with lower educational attainment or income. Within health care settings, from urban to rural and from hospitals to ambulatory care sites and clinics, there is renewed focus on efforts to advance health equity. The AHA's Institute for Diversity and Health Equity works with hospitals and health services organizations to advance health equity for all. Some of their efforts include: Improving data collection Increasing cultural competency and implicit bias training and education Increasing diversity and inclusion in leadership and governance roles Strengthening community partnerships. Since the beginning of the pandemic, people in historically marginalized communities were: 48% more likely to have died from COVID-19. 28% more likely to have been diagnosed with COVID-19. 23% more likely to be in a COVID-19 hot spot. 17% less likely to have been tested for COVID-10. 8% less likely to have been fully vaccinated. Job Loss Inequity in 2020 Black and Hispanic workers faced 1.6 to 2.0 times the unemployment rates compared with white workers. Households with less than $30,000 in annual income faced double the unemployment rates of higher-income households. Women accounted for 56% of workforce exits since the start of the pandemic, despite making up 48% of the workforce.

teaching status

Higher cost for healthcare (state of art technology, research, specialty care); Government reimbursement to decrease financial burden; Non-profit organizations

Federal Health IT Plan

Higher-Quality Care Lower Costs Healthier Population Engaged Individuals

Accreditation status

Hospital certified by TJC - ability to provide high quality care

AACN New Essentials: Domain 8 Information and Healthcare Technologies

Information and communication technologies and informatics processes are used to provide care, gather data, form information to drive decision making, and support professionals as they expand knowledge and wisdom for practice. Informatics processes and technologies are used to manage and improve the delivery of safe, high-quality, and efficient healthcare services in accordance with best practice and professional and regulatory standards.

what does the judicial branch do?

Interprets laws and their meaning, guided by the Supreme Court

scope of practice

Involves defining nursing, setting its credentials, and then distinguishing between the practices of nurses, physicians, and other health care providers; especially important to nurses in community settings, who often practice with much autonomy

Role of Informatics New ANA Standards May 22

Nursing informatics (NI) is the specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice. NI supports nurses, consumers, patients, the interprofessional healthcare team, and other stakeholders in their decision-making in all roles and settings to achieve desired outcomes. This support is accomplished through the use of information structures, information processes, and information technology.

Palliation UW Definition

Palliative care is a holistic approach to care that focuses on the physical, emotional, social, cultural, and spiritual needs of both the patient and his or her family members across the illness trajectory. The Center for Medicare and Medicaid offers the following definition of palliative care: Palliative care means patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice

palliative care

Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessments and treatment of pain and other problems, physical, psychosocial and spiritual

Innovation and Delivery Transformation: Telehealth

Pandemic Impact on Telehealth Telehealth utilization: April 2020: 78 times higher than pre-pandemic levels. February 2021: 38 times higher than pre-pandemic levels. Consumers: 40% will continue using telehealth going forward. Physicians: 58% view telehealth more favorably than they did before the pandemic. 84% offer virtual visits and 57% would prefer to continue offering virtual care. Telehealth is changing care delivery in communities across America. Virtual health care and business models are evolving, moving to a range of services enabling longitudinal virtual care, integration of telehealth with other virtual health solutions, and hybrid virtual/in-person care models. The pandemic has accelerated this shift to virtual care. Physicians also view telehealth more favorably and the majority want to continue to offer virtual care. Providers believe the top areas for telehealth expansion are chronic care management, behavioral health, urgent care and primary care. However, there are barriers that need to be addressed, including patient access to technology, uncertainty around reimbursements, integration into clinical workflows and the EHR and rural access to broadband.

Accountable Care Organization (ACO)

Patient Protection and Affordable Care Act of 2010; Developed to meet needs of value-based payment model; Care coordination and disease management; Voluntary participation to meet needs of Medicare patients (MD, Hospital, Other providers); Quality over Quantity; Reward/Incentivize high performing organizations and reduce reimbursement for poor performers; Payment based on > 30 quality goals/outcomes

Co-existing with COVID-19

Patients and the healthcare field are dealing with the after-effects of COVID-19. Post-COVID conditions include: Pain, breathing difficulties, hyperlipidemia, malaise and fatigue, hypertension and anxiety. 19% of asymptomatic patients had at least one post-COVID condition. 50% of hospitalized patients had at least one post-COVID condition. The COVID-19 virus has been costly. The estimated financial cost of COVID hospitalizations among unvaccinated adults from June through August 2021 is $5.7 billion. More importantly, COVID-19 has cost lives. The U.S. experienced 522,000 more deaths than normally expected in 2020. Life expectancy declined by nearly two years from 2018 to 2020, the largest decline since 1943. While white Americans lost 1.36 years, Black Americans lost 3.25 years and Hispanic Americans lost 3.88 years. The likelihood of death 30 days or more after initial diagnosis with COVID-19 was 46 times higher for patients who were hospitalized than for patients who were not. Cost of COVID-19 in the U.S. Life expectancy declined by nearly two years from 2018 to 2020, the largest decline since 1943. The mortality rate increased by 23% in 2020, experiencing 522,000 more deaths than normally would be expected. $5.7 billion: Estimated cost of COVID-19 hospitalizations among unvaccinated adults from June through August 2021.

The Medicare hospice benefit includes these hospice services for the palliation and management of the terminal prognosis:

Physician services furnished by hospice-employed physicians and nurse practitioners (NPs) or by other physicians under arrangement with patient Nursing care Medical equipment Medical supplies Drugs for pain and symptom management Hospice aide and homemaker services Physical therapy Occupational therapy Speech-language pathology services Medical social services Dietary counseling Spiritual counseling Grief and loss counseling for the individual and his or her family before and after death Short-term inpatient care for pain control and symptom management and for respite care and Any other hospice services, as specified in the patient's plan of care (POC) and furnished or arranged by you, as reasonable and necessary, and for which payment may otherwise be made under Medicare

Hospice care is an elected benefit covered under Medicare Part A for a patient who meets all of these requirements:

The individual is eligible for Part A The individual is certified as having a terminal illness with a medical prognosis of 6 months or less to live if the illness runs its normal course (must recertify every 60 days beyond) The individual receives care from a Medicare-approved hospice program The individual signs a statement indicating that they elect the hospice benefit and waives all other rights to Medicare payment for services related to the treatment of the terminal prognosis. Medicare will continue to pay for covered benefits for services unrelated to the terminal prognosis.

Workforce

The pandemic has exacerbated burnout and related mental health challenges facing the healthcare workforce, particularly when administrative burden, sub-optimal communications systems, and unbalanced teams collide with an extended crisis. In addition, the traumatic impact of COVID-19, especially on care providers in hard hit areas, has amplified the need for support and efforts to improve well-being. 62% of frontline workers report that worry or stress related to the pandemic has had a negative impact on their mental health. The emotional health of nurse leaders has declined. Fifty-one percent of nurse leaders reported they were emotionally healthy in the beginning of 2021, but that number dropped to 43% in August of 2021. 61% of physicians frequently experience burnout. Female physicians report the highest experiences of burnout at 69%. Members are enhancing resilience programs, adjusting staffing models, re-skilling employees, strengthening team dynamics and maximizing technology to improve workflows, patient care and the well-being of the workforce.

Think about the state regulatory board for nursing in Wisconsin. What are the primary elements regulated, and how do these activities link to health policy?

The primary element regulated by a state's board of nursing is licensure. Related to licensure are other key areas such as scope of practice and disciplinary actions. Because health policy is the result of an authorized, public decision-making process and regulatory agencies are some of the types of institutions in the United States that are authorized to make such decisions; the board of nursing through its administrative rule-making authority sets health policy. Thus, regulations related to licensure, scope of practice, and discipline, among others, are examples of health policy. State legislatures enact laws that establish boards of nursing. The functions of the board are described by the nurse practice act of each state. The boards of nursing license nurses, oversee training programs, and interpret and enforce statutory law.

Digital Health Equity

There are millions of individuals across the country who lack the technology, finances or digital health literacy needed to take advantage of digital solutions. The pandemic has heightened the need for reliable broadband for school, work and medical care. 77% of U.S. adults report having access to broadband, with the following groups reporting lower levels of access — adults in rural communities, Black adults, Hispanic adults and those making less than $30,000 a year. According to estimates from the U.S. Census, 13.9% of urban households and 19.2% of rural households do not have a broadband subscription.1 Even where broadband is available, there are millions of families that cannot afford it. 15% of home broadband users report they had trouble affording high-speed internet during the pandemic. Those making less than $30,000 had the most trouble (34%). Racial and ethnic populations, people living on tribal lands, older adults and people with lower levels of education and income also are less likely to have broadband at home. U.S. Adults' Home Broadband Access Broadband Affordability % of home broadband users who had trouble affording high-speed internet during the pandemic

Clinical Decision Support

Tools and interventions that provide clinicians, staff, patients, or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times to enhance health and healthcare.

Health System Organization Classification

Type of Institution Service Provided General or Specialized Length of Direct Care Service Ownership Structure Teaching Status Accreditation Status

networking

important strategy for power and politics - politics involves social interaction among organizations and as such, politics permeates in all organizations, workplaces, legislatures, professions, and even families (example: Getting coffee with members of the hospital research committee, in order to get to know people also interested in research); identify networks, value relationships, maintain relationships, active participation in nursing

demographic factors

increases % of elderly in society; increases % of uninsured; decreases access to care

economic factors

increasing number of uninsured patients; decreased reimbursement; regionalization; pay for Performance/Value Based

expert power

influence based on special skills or knowledge; a nurse working in dialysis for 12 years - frequently consulted by other nurses regarding inpatient policies

position power

influence derived from one's formal structural position in the organization; includes power to hire, fire, discipline, promote, and give salary increases

advocacy

influencing others (politics) to adopt a specific course of action (policy) to solve a societal problem

Organizations and Agencies that Influence Health

international organizations, federal health agencies, federal non-health agencies, state and local health departments

EXAMPLE of state and police power to act through its health system

isolating an individual or separating someone from a community because that person has a communicable disease has been deemed an appropriate exercise of state powers; the state can isolate an individual even though it infringes on individual rights (such as freedom and autonomy), in the following cases: -There is a compelling state interest in preventing an epidemic. -The isolation is necessary to protect the health, safety, and welfare of individuals in the community or the public as a whole. -The isolation is done in a reasonable manner.

values

national and state health policy reflect societal values; fairness and efficiency are two competing values often at the heart of health policy decision making; fairness and efficiency are values that drive decisions and the source of policy conflict because decision makers must be accountable for the prudent use of public funding while also considering the needs of different constituents

nurses and legislative action

nurses can be involved in the legislative process at any point; common methods of influencing health policy outcomes include the following: Face-to-face encounters, letters, emails and phone calls; additional common methods of influencing health policy outcomes include: Position papers, Fact sheets, Letters to the editor, Speeches, demonstrations, and lawsuits; the regulatory process, although it may not be as visible a process as legislation, can also be used to shape laws and dramatically affect health policy

For Profit

operate with intent to earn profit by providing healthcare services to individuals who can afford to pay; profit is distributed among shareholders; have more flexibility when offering services and can make quicker changes to increase profitable services

persuasion power

power flows from the power holder's ability to persuade or influence others; nurse is able to persuade an organization to change a policy to better serve a group of patients

referent power

power that comes from subordinates' and coworkers' respect, admiration, and loyalty

reward power

power that comes from the ability to provide rewards or favors

executive branch

president, cabinet, various administrative and regulatory departments, and agencies; U.S. Department of Health and Human Services

purpose of secondary care

prevention of disease complications; disease restorative

state and local health departments

programs vary greatly; lack of specialized skilled employees; number of imminent retirees - future shortage of public health workers; coordinating health efforts - health departments working with other departments

World Health Report purpose

provide countries, donor agencies, international organizations, and others with the information they need to help them make policy and funding decisions

mission

purpose and direction of the organization or department; how will the needs of internal and external stakeholders be met?

purpose of tertiary care

rehabilitation, long-term care

coercive power

results from managers' authority to punish their subordinates

essentials for a healthy work culture

social/emotional well-being, physical well-being, quality of work/life, mental well-being, supportive workplace

policy adoption

where the proposed intervention is selected