Purpose and Directions: This 40-point written assignment will…
Purpose and Directions: This 40-point written assignment will involve reflection of basic knowledge of healthcare finance, policy, and regulation with provided resources with a focused application to a given patient scenario. The impact of sociocultural healthcare delivery and practice and the influence of legal, economic, and political factors will need to be addressed. The nursing role of healthcare advocacy for a client will need to be discussed. This include 4 sections: 1) Patient Capsule; 2) Overview of Healthcare policy, finance, and regulation; 3) Application to the scenario; 4) Summary of how healthcare interventions could address disparities and the use of the client advocacy.
- Patient Capsule (5 points)
- a summary of the significant patient assessments from the scenario provided (including health literacy),
Patient capsule will inform the reader of the client situation and nursing concerns for the provision of health care. The patient capsule will include,
- a summary of the healthcare goals appropriate for this client
- identification of at least 2 areas where teaching might improve patient outcomes, health goals and health literacy
- Overview of healthcare policy, finance, and regulation (10 points)
The overview of healthcare policy, finance and regulation section will address a generic overview of how current healthcare policies, finance, and regulation are considered in any patient. This will include definitions and examples from the local, state, and federal levels (such as, managed care, Medicare, Medicaid, Healthy People 2020, Affordable Care Act, private insurance, American Indian options, health care disparities?refer to the resources provided)
- Application of healthcare policy, finance, and regulation specifically to the scenario client (15 points)
Application involves a reflection of the chronic health conditions, sociocultural disparities and healthcare needs identified from the client capsule. Explain the factors that will influence the patient’s health goals and how these could be addressed (such as referrals to local/bedside, state, and federal agencies, and teaching interventions). This will be a combination of the patient needs with the resources identified in the overview section.
- Summary of how health care interventions could be completed to advocate for this client and remove disparities identified (10 points)
The summary section asks the student to define advocacy and reflect on how the nurse uses advocacy to benefit the patient (use resources and education, as well), specific to healthcare policy, finance and regulation and the best method of health care delivery for this patient.
Review the case study scenario below as you are caring for the patient in your clinical setting and synthesize how health care policies, finance and regulatory guidelines influence how you provide care and care delivery. Identify and discuss the challenges this patient experiences in managing her chronic conditions. Think about your role as a nurse and the challenges you may encounter as you deliver care. Discuss how you could influence healthcare policies that can affect patients, families, within the health care system. Suggest a possible solution that you could propose at the local, state, and national level that would address this patient’s challenges in managing her chronic health conditions and healthcare disparities and needs.
Resources: There are many, many links you can access, but here are a few to refresh your understanding of the concepts and topics. Some of the link may not work, however, use Google to look up any of the subjects.
Medicaid – You Tube Video
Medicare Video -You Tube
Articles/Online links (there are many, many links you can access, but here are a few)
- The Kaiser Family Foundation: https://www.kff.org
- Center for Disease Control: https://CDC.gov or CDC – Director for Healthcare Policy link
- Center for Medicare & Medicaid Services CMS-Medicare & Medicaid Service link
- NIH site link for Healthcare policy and economics NIH links to HC policy and economics
- Indian Health Services Overview & Links
- WIsconsin Heathy People 2020-Healthcare disparities
- Commonwealth fund site–to promote better health care
- Obama, B. (2016). United States Healthcare Reform (PDF Article) Healthcare reform (Obama-2016) link
- Ubri, P. and Artiga, S. (2016). Disparities in health and health care: Five key questions and answers. (PFD) Disparities in Healthcare link to pdf
- Medicare explained (PDF) Medicare Explanation link
- Medicaid explained (PDF) Medicaid Explanation Link
Case Study Scenario:
Susan Littlebear is a 62-year old American Indian female who was brought in to the hospital by the ambulance service after she called 911. She was admitted to the medical floor with pneumonia, shortness of breath, and fever. She has a long- standing history of diabetes and chronic renal failure. On admission, Susan complained of fever, chills, and fatigue for 4 days. She normally receives hemodialysis Monday, Wednesdays, and Fridays. Susan states she “felt too sick to leave the house and couldn’t find a ride anyway.” The dialysis center is a 90-minute drive from her rural home in Merrillan, Wisconsin. Susan also has peripheral neuropathy which limits her ability to be active. She currently complains of frequent nausea and vomiting, secondary to gastroparesis. She appears malnourished. Susan has had seven hospital admissions in the last year, with the most recent admission one month ago due to hyperkalemia and fluid volume overload. Susan has received the series of two COVID vaccinations, however, she hasn’t received the booster because her neighbor’s niece’s husband tells Susan that he knows many people who have become ill after receiving the booster.
Assessments: BP 162/90; HR 118; RR: 26; T: 38.2 Oral, SpO2 91% on 2L/minute Nasal Cannula; Capillary blood glucose is 271 mg/dl; A1C: 9.9%, Hemoglobin 10.3 g/dL
Lungs: crackles bilaterally
Abdomen: hypoactive bowel sounds; Extremities: +2 pitting edema and diffuse anasarca.
Skin: Stage II sacral ulcer, Stage I right and left non healing heel ulcer, Stage I right elbow non healing ulcer.
- Chronic renal failure being treated 3 times a week. He must travel one hour to a dialysis center.
- Diabetes Mellitus Type II, since age 30
- Peripheral neuropathy lower extremities and fingertips
- Gastroparesis with dysphagia and nausea and vomiting
- HTN with aggressive medical management
- Anemia of chronic disease
Social-Cultural History: Susan lives in an apartment in rural Merrillan, Wisconsin. She is an active member of the Ho-Chunk Nation which is a federally recognized Indian tribe. She is divorced and lives alone. She does not drive due to poor vision. She has 2 children: a son and a daughter. Her son lives 30 miles from her, and the daughter lives out of state. Susan primarily relies on her son to drive her to dialysis, but at times needs to have a neighbor drive her to dialysis.