Healthcare Policy, Finance and Regulation Assignment

Healthcare professions find it challenging to effectively manage patients with multiple chronic diseases and complex social needs.  Nurses are expected to help identify the issues or challenges that affect the delivery of quality care to those patients.  Often, it is healthcare policies, finance, and regulations that impact how we deliver care.  Nurses can have an influence on healthcare policies that improve patient safety, increase quality of care, and/or facilitate their access to the resources patients need.  Due date:  You may turn in this assignment anytime during the semester to your clinical professor.  Last day to turn in is Friday, November 16, 2021 or earlier if designated by your clinical professor.  Five percent per day of the total points will be assessed against any paper that is submitted after this designated due date.

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.  The APA style written paper will include 4 sections:

1) Client 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.

Client capsule will inform the reader of the client situation and nursing concerns for the provision of health care. The client capsule will include,

• a summary of the significant client assessments from the scenario provided (including health literacy),
  
  
• a summary of the healthcare goals appropriate for this client
  
  
• identification of at least 2 areas where teaching might improve client outcomes, health goals and health literacy
  
  

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, Native American options, health care disparities—refer to the resources provided)

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 her 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 client needs with the resources identified in the overview section.

 

The summary section asks the student to define advocacy and reflect on how the nurse uses advocacy to benefit the client (use resources and education, as well), specific to Healthcare policy, finance and regulation and the best method of health care delivery for this client.

Assignment Overview

Review the case study scenario as if this were a patient you would care for 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.  Now conduct research to learn 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)

James Bearfox is a 61-year old American Indian male who was brought in to the hospital by the ambulance service after he called 911.  He has been admitted to the medical floor with pneumonia, shortness of breath, and fever.  He has a long- standing history of diabetes and chronic renal failure. On admission, he complained of fever, chills, and fatigue for 4 days. He normally receives hemodialysis Monday, Wednesdays, and Fridays.  He states he “felt too sick to leave the house and couldn’t find a ride anyway.” The dialysis center is a 90-minute drive from his rural home in Merrillan, Wisconsin.  James also has peripheral neuropathy which limits his ability to be active.  He currently complains of frequent nausea and vomiting, secondary to gastroparesis.  He appears malnourished.  James has had six hospital admissions in the last year, with the most recent admission one month ago due to hyperkalemia and fluid volume overload.  

BP 164/90; HR 118; RR: 26; T: 38.2 Oral, SpO2 90% on 2L/minute Nasal Prongs; Capillary blood glucose is 212 mg/dl; A1C: 9.4%;  

Lungs: crackles bilaterally;

Abdomen: hypoactive bowel sounds; Extremities: +2 pitting edema and diffuse anasarca.  

Skin: Stage II sacral ulcer, Stage I right non healing heel ulcer

1. Chronic renal failure being treated 3 times a week. He must travel one hour to a dialysis center.
2. Diabetes Mellitus Type II, since age 30
3. Peripheral neuropathy lower extremities and fingertips
4. Gastroparesis with dysphagia and nausea and vomiting  
5. HTN with aggressive medical management
6. Anemia of chronic disease

James lives in an apartment in rural Merrillan, Wisconsin.  He is an active member of the Ho-Chunk Nation which is a federally recognized Indian tribe.  He is divorced and lives alone.  He does not drive due to poor vision.  He has 2 children: a son and a daughter.  His son lives 30 miles from him and his daughter lives out of state.  He primarily relies on his son to drive him to dialysis, but at times needs to have a neighbor drive him to dialysis.

Point Value:  40 points

APA Paper format: Papers must be typed using current APA guidelines.  Each spelling, grammatical, or APA error will be penalized 0.25% point up to a maximum of 10% of your paper.  Late papers will not be accepted.  There is a 7-page maximum limit for this paper.  Your clinical instructor will stop reading after 7 pages.  This does not include the title page or reference page.  Therefore, be concise. There is a 0.25%-point deduction per extra page and points lost on information that was not included in the 7-page limit.