NR 447 Week 1 Discussion The Affordable Care Act Recent

NR 447 Week 1 Discussion The Affordable Care Act Recent

NR 447 Week 1 Discussion The Affordable Care Act Recent

The Affordable Care Act

Healthcare reform is a term that is ever present in our practice settings and will not disappear any time soon.
Share with the class implementation of the Affordable Care Act in your organization. (If you are not working as a nurse, think about what was happening when you were a prelicensure student)
How did your fellow healthcare workers react to implementation of the ACA?
How were citizens in your community impacted?

Health care costs have surged over time, and different populations are affected differently depending on income levels, family size, and locations, among other factors. Regardless of a person’s characteristics, a safety net is necessary when one gets sick. Health insurance coverage is the most reliable safety net. Due to economic challenges, it is crucial to support more people to afford health insurance through subsidies.

The Affordable Care Act (ACA) has several subsidies. According to Keith (2021), qualifying for a subsidy depends on a person’s income level compared to the federal poverty level, family size, and the amount a person spends on health insurance. Among these factors, income is the main consideration. A person qualifies for an ACA subsidy if they make u to four times the Federal Poverty Level (IRS, 2021). When it comes to spending on health insurance, a person qualifies for a subsidy if the spending is more than 8.5% of the household income (Cox et al., 2021). In each case, the goal is to promote access to health insurance coverage, which has been a significant barrier towards equitable and accessible

Qualifications for ACA and its subsidies differ from Medicaid to a considerable extent. The process, costs, and target group for each differ. As Pollitz et al. (2019) explained, the primary difference between ACA and Medicaid is that ACA plans are provided by private health insurance companies while Medicaid and its related support is government-administered. As a result, Medicare costs people lesser than ACA. On target groups, Medicare focuses on people from 65 years and above. Some people may qualify through disability, which is not the case with ACA. Despite the differences, the plans have been instrumental in reducing the illness burden by facilitating access to care.

NR 447 Week 1 Discussion The Affordable Care Act Recent References

Cox, C., Amin, K., Claxton, G., & McDermont. (2021). The ACA family glitch and affordability of employer coverage. KFF. https://www.kff.org/health-reform/issue-brief/the-aca-family-glitch-and-affordability-of-employer-coverage/

IRS. (2021). Eligibility for the premium tax credit. https://www.irs.gov/affordable-care-act/individuals-and-families/eligibility-for-the-premium-tax-credit

Keith, K. (2021). Final coverage provisions in the American Rescue Plan and what comes next. Health Affairs, March, 11, 2021. https://www.healthaffairs.org/do/10.1377/hblog20210311.725837/full

Pollitz, K., Neuman, T., Tolbert, J., Rudowitz, R., Cox, C., Claxton, G., & Levitt, L. (2019). What’s The Role of Private Health Insurance Today and Under Medicare-for-all and Other Public Option Proposals? KFF. https://www.kff.org/health-reform/issue-brief/whats-the-role-of-private-health-insurance-today-and-under-medicare-for-all-and-other-public-option-proposals/

I have always been one of those people who constantly ask why. I feel that knowing why I do a skill or why I give a medication is important. More importantly, I hate not having a consistent and steadfast reason when a patient asks why I am doing a skill a certain way or giving a medication. After reading your post, I was inspired to research the case of Lorenza Somera. Somera was a new graduate nurse in Manila in the Philippines. The doctor ordered cocaine injections for a tonsillectomy patient. Somera followed those orders and subsequently, the patient died. The order should have been for procaine injections. The courts found the doctor not guilty and ruled that Somera should have questioned the physician’s order. The courts charged Somera with manslaughter. It is appalling that a new graduate nurse was charged with manslaughter for following a physician’s order. Nurses now are taught to question any orders that do not feel comfortable executing. In 1929, that was not the case. Nurses at that time were educated that allegiance to the doctor meant that the patient was better served. “The Somera case sparked worldwide protests from nurses and served to push nursing toward independent practice and accountability” (Mason, et. al., 2016, p. 31). 

After the Somera case, nurses began to continuously pursue new guidelines for practice. Autonomy and patient advocacy were the forefront for this protest. Even with this push for independence and patient advocacy, it wasn’t until 1978 that the ANA code of Ethics announced that “In the role of client advocate, the nurse must be alert to and take appropriate action regarding any instances of incompetent, unethical or illegal practice(s) by any member of the health care team or the health care system itself, or any action on the part of others that is prejudicial to the client’s best interest” (Mason, et. al., 2016, p. 32). 

The Somera case brought to light many issues regarding the patriarchal relationship between nurses and doctors. It is unfortunate that Somera was charged with manslaughter but, the circumstances surrounding Somera’s involvement brought about changes that were drastically needed in nursing. If this case would have never happened, where would we be now?  We would not be discussing evidence-based practice from a nursing standpoint. 

One of the most common ways that nurses utilize evidence-based practice is with patient safety. Per Titler, “Evidence-based practice (EBP) is the conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions” (Titler, 2008, p. 113). It is vital to involve the patient and his / her family in the plan of care for the best conceivable outcomes. The patient must be aware of all possible choices and options related to care before deciding which route to take. 

To choose the best possible evidence-based practice for my unit, I should do more research. I must read the articles because none seem to relate to an adult only ED except maybe hospital readmissions. I look forward to learning new information as I research the topics. 

References: 

Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (Eds). (2016). Policy & politics in nursing and healthcare (7th ed.). Retrieved from https://books.google.com/books?id=NGGuLinks to an external site.CAAAQBAJ&pg=PA31&lpg =PA31&dq=1929+nurse+in+philippines+ charged +with+manslaughter &source=bl&ots=57JsKKMO-K&sig=qzyQExee8go9sy 0ZYA5rv_CICro&hl =en&sa=X&ved=0ah UKEwjiioaynfzVAhXK4CYKHcu9Dcw Q6AEILTAB#v =onepage&q=1929%20nurse%20in%20philippines%20charged%20with%20manslaughter&f=false 

Titler MG. The Evidence for Evidence-Based Practice Implementation. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 7.Available from: https://www.ncbi.nlm.nih.gov/books/NBK2659/Links to an external site. 

Yes it is unfortunate that it took something like the tragedy of the Somera case to bring about change and it is something we as nurses should think about moving forward.  We should always be advocates for our patients and use the best EBP to care for our patients.  Which model do you think is the easiest and most appropriate for use in nursing practice?  It there a model that you or your organization uses already? 

I believe the Johns Hopkins Nursing Evidence-Based Practice Model is the easiest and most appropriate model. “The strength of the Johns Hopkins model is its reliance on a strong academic–clinical collaboration as a foundation for mutual benefit” (Houser, 2018, p. 470).This model only has three phases, but has multiple steps within each phase. Each step is clearly defined and gives exact instructions on how to move forward. For a novice in evidence-based practice, this model would give me all the checks and balances needed to ensure I wasn’t overlooking crucial information. I do not know which model my facility utilizes but I do know that the supporting frameworks used at my facility are patient-centered care and shared decision-making. 

Reference: 

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Sudbury, MA: Jones & Bartlett. 

I also found that the “PET” tool designed and used by Johns Hopkins appeared to be more user friendly.  I also like the part where the research goes into actions and therefore we can develop a process or modify as it seen necessary. 

My present job I am a Quality Improvement Analyst and work with a team of non-clinical staff and developing processes is our business.  However, in a bedside clinical practice ACE: Evidence-Based Practice model would be a better tool to use.  I am grateful that there is more than enough models to chose from. 

When I was in nursing (which was not long ago) the professors asked the students the question why. Why are we doing it this? I remember being in clinical giving a medication and my clinical instructor sending me out because I did not have the correct diagnoses the patient was receiving the medication for. That has stuck with me. I am in wound care now, and started the job with no experience with 2 days of training! I have to look up the best researcher to prevent wounds and also how to take care of the wounds. Educating myself and the family to these new practices is very important. The best way to bring it to the beside is to practice what you have learned. 

How do you know what is the “best” practice?  How do you decipher from all the research?  Which research is considered most correct? 

I have always been taught that it depends on your patient or resident for the best practice. Individualize care is what it is about. What may work for one person may not work for the other. A good way to determine best research is the most current, and depending on the ending of the website such as org or edu. 

I would have to agree that individualized care or patient centered care is the way to go. I also believe that as healthcare has shifted to  this approach ,the input of patients and their families are vital in determining best practice.  As nurses we are to educate on options, support decision,and facilitate intervention for positive outcome. Thanks for this weeks’ insight. 

I have always wanted to know the “why” behind everything. I remember asking this question a lot as a child and getting the answer, “just because”. Unfortunately, I still hear this answer today in my nursing practice, along with “because this is how we’ve always done it”. Another response that I hear when a practice change is suggested is “why do we need to change?” or “there’s nothing wrong with the way we do it now.” People are always going to be resistant change because of fear of the unknown. If evidence-based practice (EBP) is implemented correctly, this can help decrease that fear and open people up to change. 

Evidence-based practice means utilizing the best clinical evidence to make sound patient-care decisions. By using EBP, nursing rituals and traditions can be examined and determine if they need to be replaced with practices founded by scientific research. To use EBP one must know how to obtain, interpret, and integrate it into nursing practice. I found six steps that can help make EBP a reality at the bedside. Step 1 is to identify a clinical practice problem in the unit or an idea from a research article. Step 2 is to create a team with varied clinical and research skills to evaluate the evidence. Step 3 is to develop a plan of action. Step 4 is to implement and promote the plan.

Staff education is vital in this step. Step 5 is to evaluate the results. Outcome measurements should be gather over 6 to 12 months to adequately evaluate the effectiveness of the new nursing intervention. Step 6 is to share the results. It is important to continually share the results with staff to maintain forward movement with the new intervention (Lawson, 2005). Following these steps will help to successfully implement EBP at the bedside and decrease resistance from staff that fear change. 

The best way to integrate patient and family into evidence-based practice is by involving them in the process. It is important, as I talked about in my original post, for the patient and family to be well informed about all options as to make informed decisions. 

The practice that I would decide to integrate into my practice is one that shows strong evidence for a practice change. It can’t just be based on popular opinion or on how things have always been done. Sound research that shows positive patients outcomes is needed to change practice. 

Reference 

Lawson, P. (2005). Doing it better: putting research into practice. How to bring evidence-based practice to the bedside. Nursing, 35(3), 18-19. 

I really enjoyed reading your post. I have always heard the why, it’s something behind every why after research. A few years ago at a facility I worked at, had the staff look at a video who move my cheese,  because so many were resistant to change,  and it’s always good to change if it’s no longer working,  just like medications, in any growing industry a person must be willing to be flexible in order for growth, and a positive outcome   especially when dealing with patients and their families. 

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 Professor, when I went to nursing school 34 years ago, “Evidence based practice” in the same sentence was not heard of either.  However, Florence Nightingale was my roommate (lol if it is allowed).  I began to learn about research in the 80’s when bedside care and nurses began to have a voice and a mind of there on.  We began to ask questions and comparing notes on patient care and what worked best in our monthly nurse’s meeting.  I remember questioning a physician regarding treatment of a patient with high risk of skin breakdown.  I explained to him that several patients on another unit were placed on a low-flow mattress, with a noted decrease in skin breakdown.  He agreed with my suggestion and ordered the mattress. At a monthly nurses meeting, we established a wound care committee and began creating policy and procedures for skin care integrity. There are many hospitals and Long-Term Care facilities today continue to use wound care committees and developing policies and procedures to which I am proud to say I played my part. 

  Yes we all had to find our way back in the 80s to provide the best care we knew how to our patients.  I think of some of the wound care protocols we used back then and cringe because now we know so much more because of research.  Change even now for many is difficult and requires proof that a change is needed.  In education, I ask many times “why are we still teaching this? It is not done like this anymore in real world nursing”  but until I can provide solid proof that times have changed, there will be no change.  

I can relate to not knowing about evidence based practice when I went to nursing school also.  Using evidence to support the best practice instead of just relying on existing practices, nursing care keeps up to date on the newest technological developments (Youngblut, J.M. 2001). I also have worked in wound care and I questioned the doctor about certain treatments that I didn’t agree with.  Usually with my rational & me treating the patients on a daily basis, the wound care doctor would often agree with me. At the facility that I did wound care at, we also used wound care committees and developed policies & procedures and I too had input on some of them.  It is a great feeling to be a part of that and you should always be proud of your contributions.   

I enjoyed reading your post, thanks for sharing. 

Reference: 

Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11759419