Health Care Policy X 4 (
February 15, 2020
Aligning Money, Risk, Providers, and Politics
February 15, 2020

Health Care Policy X 4 (

1) **********minimum 4 full pages ( not words)**************************** (cover or reference page not included) 

2)¨**********APA norms 

3)********** It will be verified by Turnitin and SafeAssign 

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Read well. Paper should be 1 page, and done differently 4
times (copy and paste is not accepted) you must answer the question four
times on different pages in the same document (Word)

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Question:

Complete this week’s assigned readings, chapters 39-43. After
completing the readings, post a short reflection, approximately 1
paragraph in length, discussing your thoughts and opinions about one or
several of the specific topics covered in the
textbook readings. Identify which one MSN Essential most relates to your selected topic (why) in your discussion.

Topic 1:

Advanced Nursing Education and Career Progression

The MHS places great importance on advanced nursing education. During
war, health care continues to evolve based on the nature of combat as
well as the challenges posed by working in the austere environments
characteristic of the battlefield (Spencer & Favand, 2006). Military
nurses must possess the advanced practice specialty skills needed
during conflict. Additionally, master’s degrees are required to be
obtained before being promoted to more senior military ranks.
Professional growth and development is continuously provided throughout a
nurse’s career in the MHS by way of leadership experiences, on-the-job
training, and continuing education. A variety of educational programs,
including postgraduate opportunities, are available. Full funding, in
addition to continuing to receive full salary and benefits, is provided
for nurses earning advanced practice degrees as well as those pursuing
doctoral studies. The armed services are committed to advancing military
nursing science to optimize the health of military members and their
families. Graduate education in civilian programs is available for
selected promising nurse researchers. Additionally, to further advance
the nursing research needs of the MHS, in 1992 Congress established the
TriService Nursing Research Program (TSNRP), which is the only program
funding and supporting rigorous scientific research in the field of
military nursing (Duong et al., 2005).

TSNRP funds a wide range of studies to advance military nursing
science. For example, in 2011 a pilot study was conducted to determine
the sensitivity and specificity of small animal positron emission
tomography-computed tomography (PET-CT) in identifying metabolic changes
in muscle tissue surrounding simulated shrapnel injuries, and comparing
this imaging with traditional x-ray images. Results showed the PET-CT
to be more sensitive in identifying tissue changes. Military nurses now
have a unique opportunity to educate patients and military health care
providers, as well as to inform policy changes, about the possibility of
early tissue changes around embedded shrapnel fragments and the use of
PET-CT imaging as a possible surveillance tool. Another study supported
by TSNRP in 2010 sought to understand how posttraumatic stress symptoms
(PTSS) affect couple functioning in Army soldiers returning from combat.
Findings included that almost 50% of couples had at least one person in
the relationship with a high level of PTSS. Based on these results,
development of interventions and policies designed to mitigate, or even
prevent, negative outcomes such as divorce, violence, and suicide for
military couples facing combat deployment are under way (TSNRP, 2013).

Topic 2:

Posttraumatic Stress Disorder

The problem of posttraumatic stress disorders in veterans has existed
for centuries; however, the condition is attracting high levels of
current attention caused by the conflicts in Iraq and Afghanistan and
the disorder now impacts up to 22% of veterans (Johnson et al., 2013;
Murray & Garbutt, 2012; Sabella, 2012). VHA and MHS nurses, along
with their behavioral health counterparts, have collaboratively
developed evidence-based guidelines on assessment and effective
treatments which include multiple treatment modalities such as
trauma-focused psychotherapies (e.g., exposure therapy), anxiety
management, stress reduction, guided imagery, relaxation techniques,
cognitive processing and behavioral therapy, and social support (Johnson
et al., 2013; Murray & Garbutt, 2012; Murray & Smith, 2013;
Sabella, 2012).

Current policies highlight requirements related to the timely
assessment, treatment, and follow-up care of PTSD in both DoD and VHA
clinical settings (U.S. Department of Veterans Affairs & Department
of Defense, 2010). However, most military service members and veterans
do not seek treatment for PTSD because of stigma, barriers to care, and
negative perceptions associated with receiving mental health care (Hoge,
2011; Murray & Garbutt, 2012; U.S. Department of Veterans Affairs
& Department of Defense, 2010). Policy issues requiring high
priority include better understanding of the barriers to low mental
health service use in the MHS and VHA (Hoge, 2011). Nurses are highly
instrumental in understanding obstacles to care as well as working to
develop and implement collaborative care models to increase outreach to
veterans in need of mental health services.

Topic 3: 

Sexual Assault

Although the DoD and VHA continue to address military sexual trauma
(MST; sexual assault or repeated, threatening sexual harassment that
occurs during military service) and to describe what is being done to
tackle this issue, many members of Congress believe there is an epidemic
in the armed forces. It is estimated that 6.1% of women and 1.2% of men
serving in the armed forces experienced and reported unwanted sexual
contact in 2012. These numbers are believed to be much higher given that
incidents go unreported as a result of fear of retaliation which could
impact careers and the lack of trust that appropriate action will be
taken against the offender (Johnson et al., 2013). Most experiences
(67%) happened at work on military installations (Department of Defense,
2012). This is not a new issue for the military. For over two decades
senior military officials and members of Congress have proposed
recommendations to address sexual assault and harassment. Despite these
efforts, the

330

incidence of such events continues to increase annually. This creates
substantial financial and emotional cost that affects several
generations of veterans and lasts long after a victim leaves the
military. At this point, the VHA picks up the costs associated with a
variety of physical and mental health problems (primarily posttraumatic
stress disorder and depression), which sexual assault and harassment can
trigger.

In 2013, Congress required a response to this ongoing problem. NDAA
2013 mandated immediate policy changes to include investigation of all
occurrences of sexual misconduct, requiring an independent review of all
legal proceedings and investigations surrounding MST, and improving
victim protections and reporting policies (U.S. Department of Defense,
2013). VHA mental health providers, including nurses, are developing and
evaluating therapies specific to MST. Furthermore, nurses are using
telehealth technology to reach out to veterans in remote areas of the
country.

Topic 4:

Access to Care

More recently, it has come to light that access to care for veterans
is worse than previously thought. In May 2014, the Veterans Affairs (VA)
Inspector General began to investigate patient wait times and
scheduling practices on the basis of concerns that veterans were not
receiving timely care. Preliminary findings showed that systemic patient
safety issues and possible wrongful deaths occurred as a result of
gross mismanagement of resources, unethical behavior, and possible
criminal misconduct by VHA senior hospital leadership. Before the 2014
investigation, a 2013 U.S. Government Accountability Office (GAO) report
determined that at least 50 veterans experienced delayed
gastroenterology consultations for colon cancer, some of whom later died
of the disease. Findings such as this provided evidence that delayed
access to health care is associated with negative health outcomes
(Chokshi, 2014), and these scheduling practices are not in compliance
with VHA policy (U.S Department of Veteran Affairs Office of the
Inspector General, 2014). Kizer and Jha (2014) noted that almost 20
years ago the VHA had to implement sweeping reforms to increase both
quality and accountability. The reforms of the 1990s improved quality
and increased access and efficiency (Kizer & Jha, 2014). The
successes of the past reforms in the VHA provide clear evidence that the
problems are fixable (Kizer & Jha, 2014) and new reforms are again
needed to fix current challenges. One such attempt at reform is the VA
Management Accountability Act of 2014, which has passed the U.S. House
of Representatives and gives the Secretary of the VA greater authority
to fire senior administrators. In addition, Senator Bernie Sanders
(I-VT) along with John McCain (R-AZ) introduced a bipartisan
comprehensive bill that supports veterans having access to community as
well a federal health care providers. The bill also provides emergency
funding for the VHA to hire more physicians, nurses, and other health
care workers.

Choose any of these Essentials for each of the topics and answer the question:

 I. Background for Practice from Sciences and Humanities

II. Organizational and Systems Leadership 

III. Quality Improvement and Safety 

IV. Translating and Integrating Scholarship into Practice 

V. Informatics and Healthcare Technologies 

VI. Health Policy and Advocacy 

VII. Interprofessional Collaboration for Improving Patient and Population Health Outcomes 

VIII. Clinical Prevention and Population Health for Improving Health  

Question: 

Complete this week’s assigned readings, chapters 39-43. After
completing the readings, post a short reflection, approximately 1
paragraph in length, discussing your thoughts and opinions about one or
several of the specific topics covered in the
textbook readings. Identify which one MSN Essential most relates to your selected topic (Why) in your discussion.

 

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