Policy and Global Health Trends Essay Paper
Policy and Global Health Trends Essay Paper
Provision of nursing services in the public and community domains occurs in placed where the public members play, work and live. In fact, nurses who offer public health nursing services are focus on delivering long-term, emergency, primary, and prevention care across all demographic and geographic settings to include busting urban areas and isolated rural areas. They (public health nurses) provide the care in community, home, private provider, long term care facility, clinic and hospital settings, and even engage the media. In fact, they have a deep awareness of how policies affect the public and health care received, thus making them instrumental in formation and implementation of health policy. Generally, they work with different settings and actors, the plurality of which creates unique challenges. This is particularly so when it is considered that budget and economic challenges are a reality across the country, and have caused public health nursing serious setbacks. It is evident that public health nursing is very complex since it requires nurses to incorporate all their clinical skills into a broad framework of different stakeholders and influences while looking at the whole community (Stanhope & Lancaster, 2014). The present essay acknowledges that public health nursing faces unique policy challenges, discusses the identified challenge in the context of politics and global health, and proposes strategies for addressing the challenge.
Part A: Reflection essay
Section 1.
The public policy issue of concern is prescription drug overdose in the USA, particularly the opiate crisis. Public health nurses are confronted with the opioid use crisis on a regular basis across the country with the impact affecting the all families and individuals across the lifespan, whether due to directly using prescription opioids or the family unit being affected. Individuals who present as patients suffering from prescription drug overdose present in every areas of public health nursing practice, allowing these nurses the opportunity to develop a rapport through interactions with the patients even as they offer a safe platform from which these patients can disclose their drug use. This places nurses in a unique position to use their knowledge, skills and position to raise awareness about the issue in the public domain by sharing the realities of prescription drug overdose as an epidemic, advocating for meaningful change, and working with the public who have been negatively affected (Painter, 2017).
Prescription drug overdose has had a profound effect on the public, to include impacts on communities and families, as well as increasing costs to the criminal justice, public service and health care systems. In fact, the financial and emotional impacts of this issue reaches every level of the public life with as much as 91 deaths being reported across the USA every day following prescription drugs abuse and overdosing incidences. Given that many Americans are struggling with prescription drugs (including opioids) that were directly prescribed to them or sourced from persons with these prescriptions, it is not hard to accept that nurses should be involved in efforts to combat the issue (Painter, 2017).
The prescription drug overdose epidemic is a national public health crisis. It began with common prescription medication being missed and has led to increased use of illicit fentanyl and heroin. The government is aware of the problem and has undertaken proactive efforts to combat the epidemic (Higgins & Simons, 2019). In fact, the National Institute of Health has funded research studies that have proposed several strategies to include: abuse-deterrent prescriptions, medication-assisted treatment, public education, drug courts, overdose reversal drugs, law enforcement intervention, and monitoring prescription drugs use. Other than funding research efforts, the government has funded intervention efforts with the Obama administration allocating $1.1 billion in its 2017 budget to combat the epidemic over the next two years (Bradley University, n.d.; Edmund, 2019). Policy and Global Health Trends Essay Paper Harm Reduction Coalition (n.d.) paints a much grimmer picture when noting that overdose rates have increased five-fold over the last three decades with the mortality figures resultant from drug overdose reported at 52,404 in 2015. This makes drug overdose a leading cause of death in the USA.
Nurses are uniquely positioned to help in combating the prescription drug overdose epidemic in the USA. To be more precise, public health nurses are educated to be aware of members of the public who may be at risk of abusing prescription medication, and can educate them about the associated risks. Consequently, these nurses who work directly with the public are well-positioned to contribute to this aspect of the effort against the epidemic. Besides that, these nurses can treat and counsel the individuals who abuse prescription drugs. Also, they are prescribed and can adopt responsible prescribing practice and use evidence-based guidelines to combat the epidemic (Bradley University, n.d.).
Edmund (2019) adds to the discussion by noting that despite government efforts in terms of funding intervention programs and issuing guidelines for prescription drugs administration, the issue remains a concern. It is particularly noted that the ability of nurses to use the full complement of their skills, knowledge and competencies has been limited. Whether it is acknowledged or not, nurses are part of the problem and solution. Regardless of the strategies and interventions applied, there is a need to address the issues that limit the participation of nurses in these interventions (Edmund, 2019).
Section 2.
My position is that the issue of prescription drug overdose in the USA is one that nurses can be leveraged to effectively address. The reality is that prescription drugs are an essential aspect of treatment for many persons. Another reality is that nurses are primary care providers, and are intimately involved in prescribing and administering medication. This places them in a unique position where they can inform policies on how best to address the epidemic without denying patient who require these drugs for treatment access to the drugs. To be more precise, there is a need to ensure that nurses are involved in the development of the intervention policies so that the changes do not deter nurses and other medical personnel from prescribing the much needed medication in appropriate situations. Also, the changes should not challenge the progress that medical personnel have made in medicine with regards to providing treatment.
My position on the issue has been informed by six ethical principles. Firstly, the principle of justice guides me in ensuring that every person receives a fair, equitable and just distribution of health care to include medication. This implies that even persons who are at risk of abusing prescription medication should not be denied these medication simply because they present an acknowledged risk of abuse and overdose. Secondly, the principle of beneficence guides me in ensuring that all my decisions are right and good for the patient, so that any policy proposal I make should allow patients to access the medication they require while controlling use to avoid abuse. Thirdly, the principle of non-maleficence guides me in ensuring that patients receive the medication they need and that prescription drugs management policies do not deny them the required treatment thus avoiding both unintentional and intentional harm. Fourthly, the principle of fidelity guides me in keeping to my professional nursing promise of truthfully and faithfully providing the required safe and high quality care in a competent manner. Fifthly, the principle of accountability guides me in acknowledging that I must accept responsibility for all my actions, both at the personal and professional levels. Finally, the principle of autonomy guides me in accepting that every patient is unique and has the innate right to his/her beliefs, values, perspectives and opinions, to include accepting or rejecting treatment (Black, 2016).
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Part B: Policy brief
The policy brief will be presented to the US House of Representatives Ways and Means Committee chaired by Rep. Richard Neal with the ranking member being Rep. Kevin Brady. The brief would particularly be presented to the Health Subcommittee chairperson Rep. Lloyd Doggett and ranking member Rep. Devin Nunes. The Ways and Means Committee is the main tax-writing committee in the US House of Representatives, and is responsible for presenting all bills that are concerned with raising revenue to the House of Representatives. The Health Subcommittee has jurisdiction over all health related bills that will require revenue to be raised (US House of Representatives, 2020). Through presenting this policy brief to the Health Subcommittee and getting its approval, the policy will follow the constitutional requirement in ensuring that all tax-related bills originate from the committee. The proposed policy is to increase access to prescription drug abuse treatment services, and this is an expensive endeavor that will require the federal government and other stakeholders to allocate significant funds towards these treatment services. The Ways and Means Committee is the only committee in the House of Representatives that has the jurisdiction to present this policy before the House, and it only stands to reason that the policy would first be presented to the committee for approval before being passed on to the House.
As earlier indicated, prescription drugs overdose is an issue of concern in the USA. Some of the most commonly abused prescription medication include stimulants (such as Ritalin and Adderall, depressants (such as Xanax and Valium), and opioid painkillers (such as codeine and Vicodin). In this case, the issue is typically preceded by prescription drug abuse, which involves taking medication in a different way from what was prescribed. This is include using the medication for the different purpose (such as getting high), using the medication in a different way (such as crushing and injecting or sporting tables instead of swallowing them), taking a larger dose than prescribed, and taking medication prescribed for another person (American Public Health Association, 2020).
Various risk factors have been linked to prescription drugs overdose occurrence. One risk factor is age at which the drugs were first used, with the risk increasing among those who begin using the prescription medication at a younger age. This is particularly true for kids whose use of prescription medication can change the development of their brains and bodies, increase the risk of addiction and make them more likely to experience an overdose. Another risk factor is facing stressful situations (such as trouble work, school or home), which cause the individual to turn to the medication as a coping tool or strategy for escaping the stress. This creates tolerance that requires larger doses of the medication to achieve the same effects, thus setting the stage for an overdose. Yet another risk factor is mental health issues whereby untreated psychiatric conditions change the brain activity so that the individual is prone to abusing the medication thus increasing the possibility of an addiction. The final risk factor is the brain biology that is unique to every individual. People react differently to prescription medication. There are those who feel bad upon taking the medication and are unlikely to use the medication unless prescribed to address a medical condition. On the other hand, there are those who feel good upon taking prescription medication and are likely to continue taking the medication just to continue feeling good even after being cured. The identified risk factors can occur in isolation or in combinations to increase the risk of prescription drug abuse and an overdose (US National Library of Medicine, 2019).
Prescription medication overdose has typically been addressed through intervention strategies. In this case, the treatment would involve medication being prescribed, counseling or combination of the two interventions. Counseling is typically offered through group, family and/or individual therapy with the focus being on understanding the source of the drug abuse, behavioral changes, how to deal with issues, and how to avoid compromising situations. Medication is typically prescribed to help with managing the withdrawal symptoms and reestablish normal brain functions even as the craving for the abused drug is reduced. For the more serious cases, treatment is offered in a facility-based setting where the patient remains in residence to receive treatment is as progress is monitored. Although these treatment strategies (counseling and medication) have been largely effective, they are faulted for addressing the issue after occurrence so that those who over dose and are not treated on time are considered casualties. This is unacceptable to the health care industry that has the mandate for maintaining good health and wellness. This concern is further exacerbated by the fact that prescription medication is preventable since there are discernible signs that would indicate drug abuse incidences. Besides that, there are prevention strategies whose application can effectively reduce opportunities and incidences of drug abuse. There prevention strategies include outreach and education programs that help the public to understand the risks of prescription medication abuse and how to effectively apply avoidance programs (US National Library of Medicine, 2019). While this policy brief acknowledges that prevention would be preferable to treatment, the reality is that there are individuals who for various reasons end up overdosing and require treatment. As a result, there is a need for a policy change that would make treatment more accessible and available to the public. The proposed policy is to increase access to prescription drug abuse treatment services.
There are three main challenges with addressing the issue of prescription drug overdose using the proposed policy. The first challenge is that any intervention at the national level attracts significant costs in terms of recruiting personnel, acquiring the medication, and engaging the public. In an environment where funds and resources are limited, and there are competing healthcare agendas with similar resources and funds requirements. The second challenge is that the costs of these medication are prohibitive for low income populations and persons without insurance. For these marginalized and disadvantaged populations who do not have much disposable income, drug overdose is a reality that they must deal with as they face the pressures of life and yet are unable to access the much needed treatment. The third challenge is that the treatment services are not well marketed so that populations may not necessarily be aware of the availability of these treatments. These challenges have created a situation in which drug overdose incidences continue to be reported with fatalities, and yet the persons who abuse these drugs and are likely to experience an overdose are unable to access the treatment services that they need (Huff, Kline & Peterson, 2015).
The proposed policy is to increase access to prescription drug abuse treatment services. The policy recommendation is that an independent federal agency with adequate funding should be set up to manage prescription drug abuse treatment efforts by the government. The agency would have the mandate of publicizing the treatment availability, developing affordable treatment strategies, engaging partners to reduce the cost of treatment, and getting the government to subsidize the cost of treatment. This would help in ensuring that patients who cannot afford treatment are not locked out. Through collaborating with other health care organizations, the federal agency could negotiate cheaper/subsidized treatment costs for the financially disadvantaged populations. In addition, the agency would carry out marketing activities to publicize the availability of the treatment services so as to create more awareness of the services and their benefits. Also, the agency would conduct public education campaigns to increase public awareness of the warning symptoms and when to seek treatment. Besides that, the agency would monitor the usage of the treatment services while encouraging prudent use since there is a potential of these services being misused to increase costs. Additionally, they could introduce discounts to avert the moral hazard of misuse particularly by those who can afford to pay for the services but opt for the programs targeting low income populations (Huff, Kline & Peterson, 2015).
The success of the agency would be evaluated based on seven principles: ethics, objectivity and independence, transparency, relevance, rigor, quality, population impact, and leadership. Firstly, it would be evaluated for ethics, while recognizing the importance of safeguarding the privacy, safety, rights and dignity of the patient populations and communities. Secondly, it would be evaluated for objectivity and independence with a focus on determining whether the programs have been insulated from undue influence and bias. Thirdly, it would evaluate transparency that checks whether the federal agency operates in a manner that supports the credibility of its performance while allowing for its program methodologies to be critiqued. Fourthly, it would evaluate for relevance to include considering the needs of the agency while having strong partnerships at the external and internal levels. Fifthly, it would evaluate quality by engaging experts in the health care industry to review the programs. Sixthly, it would evaluate population impact in terms of effects on drug abuse and overdose statistics trends in populations where the agency is active. Finally, it would evaluate leadership through the use of benchmarking to assess its leadership level against national levels in terms of applying innovative strategies that other programs are not applying (Cherry & Jacob, 2013).
Part C: Plan of action
Section 1.
Low income populations have an interest in the policy issue. That is because they report incidences of prescription drug overdose and yet their financial situation does not allow them access to treatment services. Like any other population, low income populations operation in the context of government policies relevant to their health through regulations, laws, resource allocation, and by shaping political issues on approach and issues. The reality is that policies that regulate and fund health care services delivery (as is the present case) are relevant to this population since it addresses a health disparity by recognizing the financial difficulties they face and making treatment for prescription drug overdose and abuse more accessible to them. The proposed policy does this by providing an opportunity for promoting health equity through encouraging collaboration, offering funding and establishing priorities (Huff, Kline & Peterson, 2015).
The proposed policy is anticipated to change the delivery, organization and financing of prescription drug abuse treatment services in important ways. It will not only expand availability and access to treatment services, but also reforms how the services are delivered while encouraging other organizations to invest in the health of these low income populations. To be more precise, the policy is expected to expand access to the treatment services through its decision making with mixed effects. On one hand, the policy is expected to reduce fatalities from drug overdose, while on the other hand, the policy could act as a potential for increasing the public use of treatment and other health care services. In addition to directly lowering the cost of treatment, the policy also influences other factors that act to keep the costs low. These factors include reducing the perceived discomfort of the care, reducing the distance to services, and reducing the appointments wait time. In essence, the policy would play an important financial role by shielding the low income populations from out-of-pocket cost and improving their overall financial status (Huff, Kline & Peterson, 2015).
The reality is that low income populations have difficulty paying for prescription drug abuse treatment services, and may need to forego some necessities (such as rent, clothing, heat or food) or borrow money to pay for these services. These populations are more likely to declare bankruptcy and be contacted by collection agencies. As such, health care bills and costs play a large role in their overall financial picture, include their capacity to make financial investments and even save. The proposed policy will substantially reduce their financial burden while increasing their financial wellbeing. Policy and Global Health Trends Essay Paper Although these low income populations have little influence over government policy change, they can leverage this policy to their advance (Stanhope & Lancaster, 2014).
Section 2.
The proposed policy intends to apply a community-based participatory research (CBPR) approach, relying on the intrinsic principles that helping in building equitable and empowering partnerships with the community members. Eight CBPR principles will be used to work with the community to address the proposed policy issue. The first principle is the commitment to sustainability and long-term processes. This will entail emphasizing the establishment of commitments and relationships that extend beyond the agency’s mandate. In addition to introducing new programs that subsidize the treatment costs, the policy will strengthen on-going collaborations among educational institutions, health care organizations, public health agencies and community-based organizations through funding new research approaches to improve treatment access (Allen, 2011).
The second principle is to disseminate the outcomes of the program and knowledge gained to the broader community and other stakeholders, ensuring that they are involved in the dissemination process. The policy and its treatment program will produce, interpret and disseminate its results to the community members in a respectful and distinct language that facilitates efforts to develop action plans to benefit the whole community. The dissemination will be conducted in an ongoing basis using a range of strategies and involving the community as coauthors and reviewers (Allen, 2011). The third principle is to balance action with research for the mutual benefit of the community. The policy will apply and balance the generated knowledge even as it building a new body of knowledge. The efforts applied through the policy will not only involve an intervention component, but would also translate research results into strategies and interventions that will address the community health concerns (Allen, 2011).
The fourth principle is to focus on the issues that are relevant to the community while applying an ecological approach that attends to multiple determinants of ill-health and health. An ecological approach would look at the whole community in terms of individual members, immediate context of the environment in which they live, and broader context (Allen, 2011). The fifth principle is to encourage capacity building and co-learning among the community members and other stakeholders. This would facilitate a reciprocal transfer of capacity, skills and knowledge (Allen, 2011). The sixth principle is to build on resources and strengths within the community. This would include building assets and skills of community members, helpful and caring social relationship networks, and mediating organizational structures such as community- and faith-based organizations. These actions are targeted at enabling the community members to proactively improve their quality of life, wellness and health (Allen, 2011).
The seventh principle is to recognize that the community can be identified as a unit of identity based on the connections between community members are they share needs, interests, goals, customs, language, values, norms and identities. The low income population is an existing community of identity, and recognizing them as a single unit or aggregate of individuals helps in building a common sense of identity (Allen, 2011). The final principle is to promote equitable and collaborative partnerships through power-sharing and empowering processes. The policy will be applied according to partnership norms that include open communication, resource capacity, knowledge recognition and mutual respect. This will allow for all parties to share control and participate in all aspects of the treatment program (Allen, 2011).
Part D: Management approach
In implementing the proposed policy, there are two management approaches that can be applied. The first approach is the top-down approach that starts with the senior management who make decisions at the executive level then deliver the decisions to the research of the staff for action. This approach has five advantages that include: availability of capacity and resources to implement decisions, decisions are aligned with rules, clear hierarchy of authority, cause and effect knowledge, and consistent and clear goals. However, this approaches has three distinct shortcomings that include ignoring issues not known to the top management, probability of wrong implementation, and possible resistance from the low level personnel (Cherry & Jacob, 2013). The second approach is the bottom-up approach that begins with input from the lower staff members who agree on the main themes that are then delivered to the top-management for endorsement and action. This approach is advantageous when innovation is required since it relies on participative ideas from many sources. Another advantage is that the decisions are easier to implement since they are well understood by all the personnel who participated in the decision-making. Still, this approach has the disadvantage of taking much time to make decisions since more persons are involved in the decision-making process (Cherry & Jacob, 2013). The two approaches are mutually exclusive as evidenced by their distinctive management methodologies, strengths and weaknesses. As such, the best strategy would involve applying a blended approach that incorporates the two. With a blended approach, the top-down approach would be incorporated to create the conditions and focus for improving performance, with the bottom-up approach incorporated to enable all personnel at all levels to take an innovative approach to improve performance and solve problems (Cherry & Jacob, 2013)..
References
Allen, A. (2011). Community-based participatory research principles. Retrieved from https://www.detroiturc.org/cbpr-principles.html
American Public Health Association (2020). Prescription drug overdose. Retrieved from https://www.apha.org/topics-and-issues/prescription-drug-overdose
Black, B. (2016). Professional nursing-e-book: concepts & challenges. New York, NY: Elsevier Health Sciences.
Bradley University (n.d.). What nurses need to know about the opioid epidemic in the US. Retrieved from https://onlinedegrees.bradley.edu/blog/what-nurses-need-to-know-about-the-opioid-epidemic-in-the-u-s/
Cherry, B. & Jacob, S. (2013). Contemporary nursing, issues, trends, & management (6th ed.). Amsterdam: Elsevier Health Sciences.
Edmund, M. W. (2019). Dealing with opioid overdose. The Journal of Nurse Practitioners, 12(5), A15-A16.
Harm Reduction Coalition (n.d.). Overdose prevention. Retrieved from https://harmreduction.org/issues/overdose-prevention/
Higgins, S. A. & Simons, J. (2019). The opioid epidemic and the role of the occupational health nurse. Workplace Health & Safety, 67(1), 36-45. DOI: 10.1177/2165079918796242
Huff, R., Kline, M. & Peterson, D. (2015). Health promotion in multicultural populations: a handbook for practitioners and students (3rd ed.). Thousand Oaks, CA: SAGE Publications, Inc.
Painter, S. G. (2017). Opiate crisis and healthcare reform in America: a review for nurses. OJIN, 22. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-22-2017/No2-May-2017/Opiate-Crisis-and-Healthcare-Reform-in-America.html
Stanhope, M. & Lancaster, J. (2014). Public health nursing: population-centered health care in the community (8th ed.). Maryland Heights, MO: Elsevier/Mosby.
US House of Representatives (2020). Ways & Means Committee: About. Retrieved from https://waysandmeans.house.gov/about
US National Library of Medicine (2019). Drug use and addiction. Retrieved from https://medlineplus.gov/druguseandaddiction.html . Policy and Global Health Trends Essay Paper
