Ethical and Legal Perspectives of the Health Care System ? I

INSTRUCTIONS TO WRITER (SEE ATTACHED RESOURCE FILES)

In 200 words or more answer each topic question (and corresponding sub-questions) thoroughly in the form of an APA formatted paper. Include three scholarly peer reviewed citations for each topic question. Reference Case Study I and Case Study II in attached Resource Files.

Topic 1: Comparing Ethical Principles
Compare two ethical principles that apply to ethical decision-making and how each one fits your own personal belief system about the role of the advanced practice nurse.

Topic 2: Advanced Practice Nursing
Choose one end of life or one right to die ethical-legal dilemma that would cause the advanced practice nurse moral distress and write the introductory paragraph for the Unit 3 assignment.

Cite and reference at least three nursing peer reviewed articles to support the content in the paragraph.

Topic 3: Ethics, Moral dilemmas, and the Law
Explain how ethics, moral dilemmas, and the law affect decision-making in your area of specialty (Radiology R.N.), advance-nursing practice.

Topic 4: Ethical Legal Dilemma Advanced Practice Nursing Case Study I
Create a draft of the Ethical Legal Dilemma Advanced Practice Nursing Case Study I

Topic 5: A Ethical Dilemma that was Shaped or Influenced by the Application of Nursing Research
? Critique a reliable Internet source that describes an ethical dilemma that was shaped or influenced by the application of nursing research.
? Include issues of licensing and credentialing within the scope of the advanced practice-nursing role and post the critique in the body of the message (not as an attachment).
? Include the link to the Internet source in your posting for review and discussion.
? Do not post the entire article to protect against copyright violations.

Topic 6: The Difference Between Licensing and Credentialing
? Discuss state requirements for licensure and credentialing as an advanced practice nurse. Be sure to include the difference between licensing and credentialing, which state you are discussing, the impact of multi-state licensure, and the legal process required to be licensed and credentialed as an advanced practice nurse.

Topic 7: Ethical Violations and Misconduct in Nursing Research
Explain three ethical violations related to nursing research conduct that violates the protection of human subjects including what ethical decisions would have prevented the violations.

Topic 8: Ethical Legal Dilemma Advanced Practice Nursing Case Study 2
Create a draft of the Ethical Legal Dilemma Advanced Practice Nursing Case Study 2 and post it here in the body of the message for comment by your peers and instructor and then, peer review at least two colleagues? posts using the Unit 5 assignment grading rubric as a guide.

UNIT 3 ASSIGNMENT Part I
Case Study I
Ethical Legal Dilemma Advanced Practice Nursing

Description

In Unit 3 you will construct Part One of the three- part assignment.

Make sure to use the most recent version of APA format. Citations and References should be no older than five years.

Directions:

1. Create an ethical legal decision-making dilemma involving an advanced practice nurse in the field of education, informatics, administration, or a nurse practitioner with a doctoral degree.

2. Include one ethical principle and one law that could be violated and whether the violation would constitute a civil or criminal act based on facts in the law.

3. Construct a decision that would prevent violation of the ethical principle and prevent the law from being violated.

Note:

? This is a fact-based assignment that will not include your opinion.
? This will require research and support for what is written.
? The assignment should be paraphrased without quotations from scholarly and fact-based publications.


To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Home.

MN 506 - Unit 3: Scoring Rubric
Ethical Legal Dilemma Advanced Practice Nursing Case Study I
[50 points]
Requirements Meets Requirements Meets Some Requirements Does not Meet Requirements Total Points
1. Create an ethical legal decision-making dilemma involving a advanced practice nurse in the field of education, informatics, administration, or a nurse practitioner with a doctoral degree.

2. Include one ethical principle and one law that would be violated and whether the violation would constitute a civil or criminal act based on facts in the law.

3. Construct a decision that would prevent violation of the ethical principle and prevent the law from being violated.
The assignment contains all requirements listed in the requirements column of the grading rubric. The assignment contains 2-3 requirements listed in the requirements column of the grading rubric or needs more clarity. Missing all 3 requirements listed in the requirements column of the grading rubric.
40 39-1 0 40
The assignment meets the current edition of APA manual writing and formatting requirements.
There are 3 or fewer APA errors. There are more than 3 but fewer than 5 APA errors. There are more than 5 APA errors.
10 7 5 4-0 10
Total Points 50

hi i am attaching montefiore medical centre(mmc) case study i would like you to answer thse questions wrt case study please

1) what are the underlying reasons for the development of new starategy at MMC ?

2) how would you describe the strategic direction which was eventually choosen by MMC and what factors influenced the choosen direction?

3) compare and contrast the new and old organisational structures, with reference to the notions of synergy and responsiveness, analyse the advantages and disadvantages of each?

4)explain what do you understand by term casual ambiguity.consider health centre value map and explain which relationships you think be more or less problamatic.give reasons

5) w.r.t MMC case, compare and contrast activity system view as recently proposed by micheal porter,with resource based view.which do you feel is more appropriate to the performance management process?give reasons

CAN YOU PLEASE ANSWER THESE QUESTIONS.
500/600 WORDS EACH.

THANK YOU

Antitrust Laws and Competition in the Health Care Market
I. Best Practices
a. Regulated vs. Non-regulated control?
b. Cost saving or cost increasing?
II. Benchmarking
a. US regulations compared to other countries
b. Advantages vs. Disadvantages
III. Statistics
a. Impact on industry
b. Impact on the consumer
IV. Future Funding Strategies
a. Continued effects on domestic economy
Conclusion

Begin working on your paper by selecting 3 scholarly journal articles that reflect your chosen issue of scarce resources (e.g. lack of access to health care; organs; anticipated lack of supply of certain influenza vaccines at peak times when it is needed; equipment and supplies shortage; leadership succession; allocation of health care resources to people with chronic diseases; allocation of health care resources to patients who are terminally ill, such using ICU/CCU beds and incurring extremes in hospital costs and reimbursement agencies, the rationing of health care resourceshow would the rationing be managed; etc. You may NOT use the nursing or faculty shortage for this paper.) and in these articles there should be a suggestion for at least one strategy for addressing your chosen scarce resource.



Write a 700- to 1,000-word editorial response (no more than 1000 words but at least 700 words) to the article, citing your agreements or disagreements and suggest one new strategy for resolution of the issue. You are required to use subheadings in this paper to delineate the paper criteria. I do not accept papers with more than 2 to 3 brief quotes, NO exceptions. Suggest an outline for this:

a. Define the issue and scope of the problem.

b. Describe five influencing factors.

c. Cite data from 3 scholarly journal articles or more sources to support the importance of the issue.

d. Address the challenges and the consequences of professionals not taking a stance to address your chosen issue.

e. Propose a creative solution or innovation; explore the degree to which economic investment is needed, and discuss why and how the lay public should join in these efforts.

university of new mexico library health sciences center
vyu (user)
V65Y21 (password)

Please use the following in some way:

Prehospital emergency care
volume 10/number 3
History of trauma field triage development and the american college of surgeons general

American Journal of Public Health
January 2005 vol 95, NO. 1
Addressing the growing burden of trauma and injury in low- and middle income countries

this should be the content for the paper , Please be sure to include a definition of quality care . if we could touch on these issues in the body that would be great . A. I will define what quality care is ?
B. Are you getting the best possible health service or care possible?
C. The Basics of Managed Health Care
D. Cost of care :
E. Prioritizing Ethical Issues

Please make sure you definitely include Conclusion and Recommendations


please note if the contents for the body wouldn't work thats fine

Assignments

Module assignments help you master the content by synthesizing the elements and integrating them into your work. While there are a variety of assignment formats, each assignment is designed to facilitate your understanding of the course material and to enhance your professional development. Some assignments (Exercises) may be relatively short answer essays, while others (Professional Development) may require more in-depth analysis or development of a project. Potential points that can be earned for each type of assignment are listed within each module.

As a general rule, responses to assignments should cover the following elements:

Succinctly summarize your response

Identify and define each element of your response using the textbook as the primary definitional source

Place your response in context through citing researched material outside of your textbook

Provide a narrative argument in support of your response, drawing upon researched material or your own personal/professional experiences

APA Format

Assignments should follow APA format. This includes a double-spaced format, with proper citation of referenced material. Please refer to the Aspen Style Guide for more information on formatting requirements:

Referencing in Assignments

Your assignment responses should be from peer-reviewed sources. You must cite your references (using proper APA format) so that readers can follow up, should they desire. You should use recent publications and ones that will provide credibility to your thesis. Unless a reference is a classic, as determined by your faculty member, it should not be more than 5 years old. Because Wikipedia is not a professionally-reviewed resource, it is not acceptable as an assignment reference.

Assignment Length

Unless otherwise stated, responses to essay questions should be over 250 words. Word count is an element of the answer, however the most important element is that the answer is fully developed and addresses the four points mentioned above. Answers under 250 words will rarely receive full points, however simply because an answer is over 250 words does not grantee full points.

Exercises:(80 points)

Health care planners could be more effective and efficient if they used the concept of the natural history of disease and the levels of prevention to design services that intervene at the weakest link in the chain of progression of specific diseases. Instead, most focus on high-technology solutions to preventable problems. Assess the characteristics of the medical care culture encourage the latter approach.

Hospitals and other health care institutions, whether voluntary or for-profit, need to be financially solvent to survive growing market pressures. Describe how this bottom line focus has changed the nature of the US health care system.

The insurance industry plays a huge role in the American health care system and absorbs a significant portion of the health care dollar. A single payer system, whether it is a private company or the US government, would eliminate the complex insurance paperwork burden and free substantial funds that could be diverted to support care for the under-served. Why do you believe that so much resistance to a concept used in every other developed country has continued in the U.S.?

Attach the assignment as a Word document or comparable file format.
There are faxes for this order.

I need a original marketing plan for the East Boston Neighborhood Health Center which is located in East Boston, MA. I would like to market to the Hispanic women in our community the post partum depression support group. The support group would be a drop in group that meets twice a week. There would be a bilingual behavioral health specialist that would run the group. Spanish speaking women and their babies would be welcome (babies up to one years age). The East Boston Health Center services predominately Spanish speaking single mothers with little to no support who are undocumented. The group would provide support and friendship for women.

PROFESSIONAL PLATFORM FOR ETHICS AND LEADERSHIP
Writers in health care ethics repeatedly emphasize the role of the health care professional as a moral agent or a person whose actions affect self and others at a moral level. Many writers further emphasize the importance of a personal ethic or moral framework in which the health care practitioner grounds his or her practice and professional relationships. Ideally, the content of this course gives the students an opportunity to consider their own personal and professional ethic within the various theoretical standpoints and case studies presented. The purpose of the Professional Platform for Ethics and Leadership is to initiate and facilitate a well articulated foundation for leadership and ethics in practice.
The platform is worth 100 points. Please note, points are awarded based on the clarity and depth of your writing and the apparent effort given the assignment -- NOT on the rightness or wrongness of your position. Students are encouraged to be honest in their self-assessments and conclusions. The Professional Ethical Platform is due no later than Sunday, 11:59 p.m. Mountain Tine Zone of the week indicated in the Course Outline/Course Syllabus/Weekly Overview.
DETAILED INSTRUCTIONS
The ethics platform is a written essay demonstrating deep reflection on the nature, sources and implications of the values, beliefs and ethical perspectives that guide your personal and professional practice. The recommended length of the paper is 10-15 pages--more pages does not always equal a better paper, excluding the cover and reference pages, double-spaced with a 12-point font. Papers will not be penalized for exceeding 15 pages in length--more pages does not always equal a better paper. The essay may address areas beyond those found in the required information, and should reflect your own individual perspective and approach to ethical and leadership practice. However, the paper must minimally address the following items:
1. Identify the primary influences in your own ethical development and leadership perspective from childhood to the present. Describe any experiences or people that have had a particular impact. (2 to 3 pages.)
2. Examine the six ethical principles discussed in class (autonomy [respect for persons], nonmaleficence, beneficence, veracity, fidelity, and justice). Choose 3 or more principles that are most important to you. How important are these principles in relation to each other when they are in conflict? Under what circumstances have you, or would you, feel justified in violating one or more of these principles? What other values support or conflict with these principles? (2 to 3 pages.)
3. Most of us find ourselves using several or all of the ethical theories described in your readings; however, most of us are also generally inclined to one or two particular theories. Comment on which of the ethical theories seems the most consistent with your own perspective. Which ethical perspective is the most troublesome to you? Briefly explain why. (2 to 3 pages.) The ethical theories include Kantian deontology, Rossian deontology, utilitarianism, virtue ethics, Catholic moral tradition, Rawlsian ethics, rights-based ethics, communitarian ethics, feminist ethics, and ethic of care. You may also present a cultural or faith-based perspective not covered by these theories.
4. Using the ethical concepts from your answers to #2 and #3 above, when working with patients, families and other health care professionals, how do you see yourself working to resolve ethical disagreements (1 page)?
5. Describe your view of the ethical practice of nursing (1 page).
6. Healthcare professionals are often challenged to assume leadership roles in order to improve clinical practice, advocate for patients, further or protect the interests of the profession, challenge unethical practices by colleagues or facilities, and actively work to shape meaningful health care policy. The Johnson text explores the ?shadow? side of ethical leadership. Discuss the shadow side of your own ethical practices and leadership behaviors; what are your opportunities for development. (1 to 2 pages.)
7. Articulate a realistic plan for personal and professional development with respect to ethical and leadership practice. State your plan in terms of specific and measurable goals, objectives, and a timeline. Describe how you will be held accountable for meeting the elements of your plan. (1 to 2 pages.)
This is a very personal assignment. Students are encouraged to be honest in their self-assessments and conclusions.
SCORING RUBRIC
CONTENT POINTS
Primary Influences
--Identifies the primary influences in ethical development and perspective, including any experiences or people that have had a particular impact on personal ethical viewpoint. 15
Ethical Principles
--Discusses the various ethical principles in terms of which principles are most important, how situations are approached in which principles conflict, and any other values that support or conflict with these principles.
--Presents logical justification for choices. 15
Ethical Theories
-- Identifies those theories that seem most consistent with one's own perspective and those theories that seem least consistent with that perspective.
--The discussion contains enough depth for the evaluator to assess the personal understanding of the concepts.
--Identifies and addresses any inconsistencies in the personal views.
--Presents a framework by which ethical disagreements are resolved. 20
Ethical Practice of Nursing
--Details those ethical components deemed necessary to the practice of nursing.
--Does more than simply repeat the Nursing Code of Ethics; presents a well-developed and experientially-based construct. 15
Leadership Shadows
--Explores the shadow side of personal ethical practices and leadership behaviors, identifies opportunities for personal development. 15
Personal Development Plan
--Articulates a plan, with specific steps, for personal and professional development with respect to ethical practice. 10
Organization / Writing / APA format 10
TOTAL 100
GENERAL REQUIREMENTS
There are many approaches to ethical analysis and each has inherent strengths and limitations. Compelling arguments can be made on both sides of most ethical dilemmas. As such, your work will not be evaluated on the basis of the rightness or wrongness of your position. However, it will be evaluated on the basis of presentation and the depth and clarity of your analysis. All papers will be generally evaluated as follows:
Content:
? Is each required element addressed with clarity and depth?
? Do the various concepts discussed reflect an accurate understanding, interpretation and application of ethical theory and principles?
Organization and Presentation:
? Is the essay well organized and engaging to the reader?
? Are ideas expressed clearly in writing?
Writing Mechanics
? Does the essay meet acceptable writing standards for graduate work?
? Is the paper formatted according to the style prescribed in the 6th edition APA manual?
? Are references cited appropriately within the body of the paper and the reference list?
PROFESSIONAL ETHICAL PLATFORM CHECKLIST
Here is a checklist to help you evaluate your paper in relation to the grading criteria.
___ Is the paper written in accepted APA format?
? 1 inch margins, body double spaced with paragraph indents
? Cover sheet
? Title at the top of the first page
? Running header and page numbers
? Proper use of APA section headers
? APA style references within the body of the paper and an APA style reference list
NOTE: Papers that do not substantively comply with APA format will be returned unread. This is a graduate level standard.
___ Have you avoided plagiarism? Any time you use someone else?s words verbatim or even closely paraphrased, you must cite your source. For example, if you use a source that suggests a particularly effective interpretation of a particular ethical principle, cite that source in your discussion. Direct quotes should be in parentheses and the page number included in the citation (author, date, page).
___ Have you carefully proofread the paper for misspelled words, grammatical errors and clarity of presentation? Try reading the paper out loud, or have a friend read the paper and serve as editor.
The Department of Nursing requires that current American Psychological Association (APA) standards for style be used. This is an important aspect of scholarly writing and you are strongly advised to follow the style manual carefully. These details can be found in the Publication Manual of the American Psychological Association (6th ed.). You should to obtain a current edition of this manual for reference. The APA manual (6th edition) is available through the Regis University Bookstore and can be purchased on line. APA websites are also useful.
Books used for my class are:
1. Meeting the Ethical Challenges of leadership Casting light on shadow by Craig E Johnson 4th edition
2. Ethical issues in modern medicine, contemporary readings in bioethics by Bonnie Steinbock, John D Arras and Alex John London 7th edition



Who Am I
Who am I? I am the product of my environment, a credit to my Irish heritage, a compassionate caring person who enjoys life to the fullest. I am a woman of character and integrity, a mother a friend, a sister, a counselor at times, a good listener, a follower of Jesus Christ, a missionary, a teacher and a nurse. I am a strong leader with a type A personality. Hard work is my motto and idle hands are as my mother used to say ?the devils workplace?.
1. Where were you born and what is your nationality & heritage?
I was born and raised in Ireland in a small village of approximately 100 families, where everybody knew everybody?s business. I am Irish. My heritage is part of the old traditional friendly, loving and caring group of people. I immigrated to the US on December 31st 1977.
2. Describe how you were raised and your family life. (schools attended, religious preferences, profession, etc.)
I was raised in a traditional Irish home, and am number five of eight children. The house was a small two bedroom home with no running water and an outside latrine. We lived on a small farm that was handed down from generation to generation over a period of 125 years. My family life was difficult growing up as my father was a violent alcoholic and a wife abuser. My mother was a loving, gentle caring person. She instilled in us a love of life, a strong penchant for responsibility at an early age and a need to work hard, get a good education and strive to do the best in life.
She wanted all the things she did not have in her life to be ours and she would say ?nothing is impossible with God; you can do all things through and with him?. Our family was staunch Roman Catholic and we were encouraged to attend church on Sundays and all holy days of obligation. My dad was an engineer and worked on the bridges and roads in our county in the midlands of Ireland in the county of Longford. I attended the local catholic schools from primary school through college. I choose nursing as my profession at the early age of seven while attending to my grandfather?s diabetic ulcers. (The nurse from our clinic taught me how to dress his wounds) This procedure instilled in me a desire to learn more about how and what a nurse was and does. I was intrigued and admired and respected her. She was an upstanding member of our community and everybody loved her.
3. Explain your views toward these elements of culture: work, dress, hygiene, courtship, gender and status.
We did not have a traditional dress other than wearing tweeds and a special type of knitted sweater called an ?Aran Sweater ?This sweater had a type of cable knit that depending on the clan you belonged to, depicted for example that she was from the ?Keegan clan?. One of the reasons for this specific cable was that prior to the era of DNA (the Irish were fishermen and relied on the sea for their food,) if a fisherman washed onto shore his sweater would denote what clan he was from, if the body was too decomposed to identify him.

Our work ethics were instilled in us by our parents. This reflects on how I look at life and others, and how I live my life. Our textbook states that ?knowing who you are is never simple, it is an ongoing process that can never fully capture the ever-emerging person.? (Martin, 2010 p. 36)I am still emerging as the textbook states. The motto in our home was to ?spare the rod and spoil the child?. We all had our chores and they had to be completed prior to leaving for school each day. Hygiene as I was growing up was a little more difficult as we did not have running water. We had a basin of water and soap (lye) and washed ourselves each day prior to going to school. Saturday night the aluminum bath was brought in and water was heated on the stove, boys went first in the bath tub, then the girls. Another saying my mother had was ?cleanliness is next to Godliness?. We were not allowed to leave the house for any event before we were inspected head to toe and behind our ears to see if we were clean. Clean underwear was a must before we left the house.
Gender in the traditional Irish home was like many traditional cultures that are the men come first. We had to look after the men and boys first then the girls could be taken care of. Courtship was under the strict morals of the catholic doctrine. The parish priest Father Pat ruled our community with an iron fist. He would walk the grounds of the local schools on weekend nights with his blackthorn stick and we were all aware that boys and girls were not allowed to be alone. If we were caught we would have to pay the wrath of Father Pat and that was a good beating with his stick.

He would also announce from the pulpit that he caught so and so doing things that they should not do. The birds and the bee?s stories were taught to us by our peers as sex was a taboo word in our homes. The rosary was recited every night in our home as we were growing up.
4. Briefly describe a typical day from morning to night in terms of the cultural values that govern your actions. Write a minimum of 10 actions that you do in a typical day.
I work nights so a typical day for me when I work the night shift is to get up around two thirty in the afternoon and brush my teeth wash my face and hands and as I now live alone I come down and spend about 30 minutes on a quiet time reflection with God. I then talk with my daughter via phone as she lives about 30 minutes away from home. I catch up with my errands, clean my house, do my laundry, prepare my work clothes and sit down and work on any of my readings and or homework so I can prepare any outlines for papers that need to be turned in that day. I typically spend one day a week preparing the weekly food so I have time to spend on recreational activities, family time and chores or school work on the remaining days.
I eat my meal around 1700 and take my shower and then I head off to work which is about 30 minutes from my house and start work at 1900 hours. When I am not working, my day starts out again with a quiet time and reflection with God. I take some time out to meet with my family and perhaps prepare a meal for them. We enjoy playing board games and are very competitive as a family. Family is a very important component in our traditional Irish homes.

4. Provide some characteristics of your culture from one or more of the following:Transmitted from generation to generation; cumulative and historical
An Irish family gathering is composed of friends playing the Uileann pipes (a form of bagpipe) and regardless of the fact that we have a musical note or not, we all chime in. We often sit down around a jigsaw puzzle and work as a team to complete the puzzle. Music is usually in the background. The elders will tell stories to the children and that often keeps the children intrigued for a long period of time. A game of football or soccer will be played in the backyard if it is a good day otherwise the men and boys in the family will be cheering on the soccer match on the television.
5. What rules in your home do you follow unconsciously?
I usually have a strict adherence to my faith and unconsciously have my quiet time each morning. I also keep a close relationship with my family and friends.
7. Relate a folktale, song, work of art, proverb or something similar about your personal culture.
Always remember to forget
The troubles that passed away.
But never forget to remember
The blessings that come each day.
May misfortune follow you the rest of your life, and never catch up.

May those who love us love us,
And those that don?t love us,
May God turn their hearts,
And if he doesn?t turn their hearts,
May he turn their ankles?
So we will know them by their limping.
Author unknown.
8. How has your cultural values been determined by historical events?
Ireland during the 60?s was still in a state of unrest. The rebel factions of the Irish Republican Brotherhood and the British counterparts were still causing trouble. The catholic/protestant political and religious viewpoints were very strong. The Protestants were considered the elite, landowners (they threw us off our lands during the British take over) Today in Ireland this old adage no longer rings through but it continues to affect our lives in a way that can be distrusting of others who would attempt to control our family life or our worldviews. Our tradition and our heritage, one of friendship and hospitality, is why the Irish culture is renowned around the world and people have traveled to our country to see what makes us a nation of friendly compassionate people.


9. What customs and traditions do you observe in your culture?
St Patrick?s Day is a holiday and we honor him for bringing Christianity to our pagan land. Although a lot of celebrations surround food and drink, the family all join together to enjoy our freedom and our love of music and good Irish food. Christmas time is similar to that of the US except that we place a candle in the window to light the Christ child in. this signifies that there will always be room in our inn.
10. What influences or guides your behavior? (Your ethics)
Ethics as stated in our textbook on Intercultural Communication In Contexts is defined as ?principles of conduct that help govern the behaviour of individuals and groups? (Martin, 2010 p. 32). My upbringing instilled in me a love of music, song and dance and a penchant to give back a little of what I had that others are less fortunate to have in todays world. My work as a missionary was also a product of the stories of the Boer War in Africa that my grandfather told us as children sitting at his feet during the storytelling times. He taught us about the missionaries who helped them through the difficult times and the terrible fevers and diseases that the soldiers suffered during their time away from their families and friends. I always dreamed that one day I would be a person that would govern the behaviour of others in a foreign land. God was faithful and today I travel back and forth helping those less fortunate than myself in the continent of Africa. Last year I helped open a school of nursing in Northern Kenya called the ?Nzoia College of Nursing?.

11. Other behaviors you may have culturally learned:
I learned that we must take responsibility for our actions and or pay the consequences for our actions or inactions that would hurt others.
a. How do you deal with conflict?
Conflict is a part of our lives. I deal with it by being upfront and honest; I like to speak the truth in a loving way but yet letting the perpetrator know that the action is inappropriate. I use the bible as a guide as Matthew18:15-17 dictates to us how to deal with conflict. ?If your brother or sister sins go and point out their fault, just between the two of you. If they listen to you, you have won them over. But if they will not listen...? (New International Version, NIV)
As a leader and a Nursing Administrator, we deal with conflict on a daily basis. My first step is to listen to the person or persons that created the conflict and hear both sides of the story. I then approach them and ask what they would have done differently if they had to do it all over again? I try to get them to work out their problems mutually and if that is not possible I will talk with them separately and attempt to resolve the problem. If that does not work then I would use the chain of command to resolve the conflict.
b. How close do you allow friends to be in your space (i.e., personal bubble)


That depends on the level of our friendship. Is he or she an acquaintance, colleague or close friend? Our Irish culture is one of acceptance and friendship. We are loyal to our true friends and employers. Personally, I am a very private person and this assignment proved to be a little out of my comfort zone. In our home growing up we were thought to keep our skeletons behind closed doors. In other words we did not air our dirty linen in public. My mother was a victim of domestic violence and we as children were traumatized by it. We did not tell our friends because that would bring shame and dishonor to our family. After many years of counseling, I was able to let people into my personal space, however if they violated or betrayed my trust, a wall would go up and that person would never be allowed in my personal confidence or space again. He or she would not be ostracized from my life but would not be privy to my personal confidences. I would then maintain them on the level of an acquaintance.
In conclusion, who am I? I am part of a close knit family, dedicated to my friends and family. My faith defines my morals and ethics in life. I am a hard worker a woman of character and integrity. I am a mother, sister teacher, counselor, nurse, leader and a good listener. I am a traditional Irish woman who upholds her heritage and is loved by many for my dedication to my work and the mission fields of Africa.
I am not afraid of hard work and am an overachiever and competitive who loves life, music and family. I am the product of my early environment. I am who God made me to be. I am a woman of strong morals and integrity. My character is the same at home and out in the community

My senator is: RAND PAUL (Kentucky)
1. You will bedeveloping two position papers. Acting as the Senator (talk in first person) you have been assigned to portray, you must develop position papers on two issues: Immigration Policy and Health Care. Each paper must be 3-5 pages long (further details below).(*so one paper on immigration policy and a separate paper on health care combined into one file*) You can get position information from your Senators web site, but I expect you to research beyond that. Go to secondary sources to get a fuller understanding of what your Senator supports and why. You might be quick to make certain assumptions about how a Senator from Arizona or a Hispanic Senator might position on Immigration, but be careful, because these assumptions might be wrong. I want the issue positions to be inclusive and complete. I also expect a critical analysis of the Senators positions (this is where you leave first person and go to third to analyze) . You need to consider the Senators role on the issue.

The papers must be typed, doubled-spaced with normal margins and font. They must me well organized with a thesis statement, a sophisticated argument and a conclusion and the positions must be accurate to your Senator and supported by detail. There must be citations for any information that is not common knowledge and a works cited or bibliography page at the end of each paper. Use MLA formatting guidelines. The other thing you will need to include in each paper is a critical analysis of the Senators position and role in the debate. (*third person) --> This part has to be a minimum of page but should be closer to 1 page as you question what the Senator is doing on the issue, why he/she is doing it, if it is working and how it fits in to the overall debate on the issue today. This needs to be deeper than questioning the fact that a Democratic Senator has liberal beliefs. For example, Im not asking you to tell me if you agree with your Senator taking a pro-life stance because you are pro-life. What you need to do is tell me something about how he/she is making their case and whether it is effective in the overall debate, or something like that.

For this Application assignment, due by Day 3 of Week 11, you will examine an authentic workplace quality improvement need at the unit level and use data to support a specific quality improvement approach. You will apply a quality improvement model to your identified need, determine members of a quality improvement team, and identify a leader who will champion your quality improvement initiative. This Application Assignment provides you with an authentic learning experience as you walk through the steps of planning a quality improvement project.

To prepare:
Focusing on quality improvement at the unit level?not at the organizational level?select one nursing sensitive indicator that is in need of significant improvement at your practice setting.


Remember, indicators can range from not meeting customers? expectations to inability to fulfill organizational goals. You may wish to review the NDNQI indicators prior to beginning this Application.


Articulate a hypothetical or real quality improvement initiative that is specific and has a localized focus.


Analyze the culture of the patients and providers that this initiative will impact.


Determine processes that need to be implemented to ensure a smooth transition.


Consider the stages that the practice setting would go through over a nine-month time frame.


Examine data that supports the need for your improvement initiative and determine which quality improvement and patient safety tools would best represent the data (flow charting, cause-effect diagrams, control charts, root cause analysis).


Select team members for your quality improvement effort.


Identify who at your practice setting would be the ?senior leader? or sponsor for meeting the improvement needs of chosen indicator.


TO COMPLETE:
In a paper approximately 15?20 pages in length: Topic should be improving customer service on a medical surgical nursing unit.

Part 1: State the problem and mission in measurable terms; clearly state the unit of analysis.

Explain why your selected nursing indicator is a priority for your organization and support your selection with data.


Identify which quality improvement model best fits your nursing indicator and justify your selection with evidence from the research literature.


Detail the primary measurement that you will be utilizing, and the goal, in comparison to an external source (i.e. scores received by other similar health care organizations on your nursing indicator).


Synthesize strategies for managing any ethical dilemmas presented by the initiative.

Part 2: Describe the team: membership, roles, facilitators, background/experience, and motivation within, followed with an analysis of the leadership role of the sponsor for this project.

Document the team process: determine meeting frequency, ability to fulfill roles on the team, etc. As this is a simulation exercise, you will create this information using best practices as a guide.


What leadership qualities should this ?senior leader? or sponsor possess?


Do you believe this sponsor to be a transactional leader or a transformational leader?


What managerial attributes and actions would this senior leader need to employ to ensure that the staff will buy into workplace changes?


Predict how the senior leader role will evolve throughout the quality improvement journey.
Part 3: Formulate possible evidence-based practices and an action plan that could work towards achieving improvement outcomes.

Provide insight into the diagnostic processes (e.g., root cause analysis) used to determine the primary causes of the problem. Consider both qualitative (cause-effect diagram, barrier analysis), and quantitative (theory testing or drill down analysis) methods.


Analyze the cost-effectiveness of your initiative and how your initiative mitigates risk and improves health care outcomes.

Part 4: Summarize the impact of the team process on the nurse sensitive indicator.

Analyze monthly or weekly data points of the nine-month period.


Include a timeline that documents the various milestones seen from implementation to completion of the nine-month quality improvement model. You may use the quality improvement model of your choice (PDSA, DMAIC, Lean).


Demonstrate meaningful improvement utilizing a key metric such as graphs, control charts, or other valid statistical analysis capable of showing trends.

Part 5: Summarize the positive attributes of the team process in creating improvement.

Attributes can include, but are not limited to: motivation to improve, conflict and conflict resolution, change theory as applied to implementation strategy, negotiation, the role of senior leader in securing resources for the team, and other organizational and team dynamics.

Individual reflective paper:
Compose and be three to five page reflective essay on the following components:
* Describe the key initiatives included in the Patient Protection and Affordable Care Act.
* Discuss the single initiative that will most negatively affetc the overall national healthcare cost.
*Discuss the single initiative that will most positively affect the overall national healthcare cost.

APA format is required.

How does the current budget crisis impact the public Health & Community services in the following individual states? (3 pages)
1) Colorado
2) South Carolina
3) New Hampshire
4) California
5) Arizona
6) Oklahoma
7) Virginia

Select a current health care bill that addresses one of the four components of health care and it's impact on health services in the community. Include the following:
1) Identify and summarize which component of health care the bill addresses.
2) Describe the health care bill, including the health care issue that the bill addresses. Why is the bill necessary?
3)Identify proponents of the bill and those that oppose the registration and state their position (i.e.,why do they disagree?)
4) Explain how the bill helps or hinders health services in the community.
5) Describe how the bill impacts health care professionals and how it impacts those that have to follow the bill's directives.

Future Reform

Write a 5-7 page paper in which you: 1.Predict the form and function of medical health records in 2030 (provide specific example to support your response).
2.Describe the most likely impediments to health care information access in 2030 and make at least two (2) recommendations to avert those impediments that can be implemented now.
3.Discuss the single most significant ?health care bake in? you could embed into organizational workflows and the probable impact it could eventually have.
4.Cite at least two (2) references from peer-reviewed sources to support your argumentation.

Submit a 2,100- to 2,450-word paper on the effect technology has on decision making. The paper must include:

? An introduction
? A discussion on systems and informatics theories
? A discussion on the DIK Model
? The role of expert system in nursing care and medicine
? The use of decision aids and decision support systems
? The uses of technology for patient and client management
? An analysis of the effect of technology on health care and health status
? A conclusion
? At least five references from the University Library

Format the paper consistent with APA guidelines.

TOPIC/ISSUE: Present how strategic planning, performance improvement, and information systems are interrelated and fundamental to the delivery of quality health care.


1. Introduction
Describe the issue, why it was selected, the perspective of approach, and the scope of the paper or presentation. In essence, describe in this area what is being covered. Be specific and to the point. This is an important part of the project as it engages the reader and sets the scope of the research.

2. Statement of the Issue to be Investigated
Describe why the issue/topic is a relevant, a problem/issue. It is important to provide literature sources in support of the importance of the need/issue/topic. Overall, what makes this topic/issue so important that you are spending time/energy researching it? What is the impact of the problem if nothing is done to correct the situation?

3. Research Sources
This section documents the relevant research reflecting the topic of the research paper. In this section, paraphrased narratives of the actual research studies are reported and should represent the current research related to the topic area. In general, your research should:

a. Identify your chosen topic and what has happened in the specific research of the topic (describe the study, sample, findings, important points from the discussion in the research article, and any variables that may influence the findings of the research).

b. Discuss any key elements of the topic that may be instructional, legal, ethical, social, etc. (what is projected if nothing is done? what has been tried?). Support this section with relevant resource citations.

c. Provide an analysis of the research articles used, including: explaining what was done in the study, what the target population was, information about who did the research (the author), what was found with the study, and any implications of the findings to your topic or issue.


4. Conclusion
In this section, provide a general, but thorough summary reviewing: why the topic was selected; the problem/issue briefly stated; the approach that was used; findings; and solutions. In this section, a reader should be able to understand the conclusion/summary and have a good idea what the researcher did and what was found.

Your reputation as a renowned administrator to successfully lead mergers and acquisitions of hospitals precedes you, and you have been hired to create and open a new specialty health care business. This is a clinic with physicians who specialize in the following areas: dermatology, gynecology, heart disease, respiratory disease, surgery, and gastroenterology. It is located in an exclusive neighborhood.

1.Determine whether you would incorporate and state the advantages and disadvantages of doing so.
2.Determine the feasibility of a profit or nonprofit organizational status for this facility.
3.Create a contract structure, including four (4) necessary clauses, for inclusion for medical staff for this facility.
4.Outline a plan to hire or appoint specialists for the clinic.
5.Justify the decision to accept Medicare or Medicaid as potential pay sources for this exclusive clinic.
6.Use at least five (5) quality academic resources in this assignment. Note: Wikipedia and other Websites do not quality as academic resources.

Write an eight (8) page paper that addresses the following:
1. Discuss the relationship between risk and insurance.
2. Determine what ethical concerns health care management / administrators professionals have to contend with resulting from the supply and demand of insurance.
3. Determine whether the income of an individual should not be a consideration for health insurance providers. Explain your rationale.
4. Determine which factors drive consumer demand for insurance and how management can leverage information obtained from empirical measurements.
5. Recommend an approach that would effectively mitigate the issues associated with measuring the health care demand.
6. Evaluate the relevance of the Lemons Principle: Health Insurance to the current health care system(s) in the United States.
7. Use at least five (5) quality resources in this assignment. Note: Wikipedia and similar Websites do not qualify as quality resources.

Since the inception of the HITECH Act, health organizations have faced increased pressure to update their health information technology (HIT) resources. As discussed last week, many believe that the increased use of electronic health records and the quick and efficient communication afforded by HIT can lead to improved quality of patient care. Yet there are significant costs associated with implementing such systems. What can organizations do to ensure that the correct system is selected and that the system will be appropriate for those required to use it? Who should be involved in those decisions?
This week introduces the systems development life cycle and discusses how it can guide an organization through the complexities of adopting a new HIT system. In this Discussion, you are asked to consider the role of nurses in the SDLC process.
To prepare:
Review the steps of the systems development life cycle.
Think about your own organization, or one with which you are familiar, and the steps the organization goes through when purchasing and implementing a new HIT system.
Consider what a nurse could contribute to decisions made at each stage when planning for new health information technology. What might be the consequences of not involving nurses?
Reflect on your own experiences with your organization selecting and implementing new technology. As an end user, do you feel you had any input in the selection or and planning of the new HIT system?

You are employed in an administrative position at a large health insurance company. The board of directors of the company will be instituting a get health/stay health clause in their health insurance policies. This clause would state that all insurance recipients must complete a health review which will include a complete physical, blood pressure check, cholesterol check, blood glucose check and BMI. The insurance recipient will be rated utilizing a point system on the above criteria. Any health insurance recipient who scores above a certain number (which is an indicator of an increased possibility of health problems) will be required to pay a higher premium (the higher the number, the higher the premium). This higher insurance premium will continue until the health insurance recipient reduces their blood pressure, cholesterol, BMI, etc. and receives a lower rating.

Answer the following questions:

1) Can an insurance company require insurance recipients to pay a different premium for the same coverage? Is this legal? If yes, what law or statues takes precedence? If no, which law or statue takes precedence? (Answer EACH aspect of the question including legality issues. Defends legality conclusion. Incorporated pertinent laws.)

2) Can the insurance company require the insurance recipient to undergo required tests? What if the insurance recipient refuses to comply with the testing requirement? (Answer EACH aspect of the question including medical testing and compliance. Incorporated pertinent laws.)

3) Is the insurance company discriminating again the insurance recipients who have heredity or predisposing health risk factors. Why or why not? If so, is this practice ethical? (Answer EACH aspect of the question including discrimination and predisposing risk factors. Incorporated pertinent laws.)

4) Is the health insurance company legally and/or ethically required to offer assistance for insurance recipients who need to lower their rating? Support your opinion. (Answer EACH aspect of the question. Explains ethical and legal ramifications of requiring insurance recipient testing. Incorporated pertinent laws.)

Note:
a) Include an introduction and conclusion.
b) Re-state each question prior to answering.
c) In answering these questions, include any pertinent laws. APA format is required.
d) You must have a minimum of 4 online references with appropriate in-text citations (Use only online (!) sources and free (!) accessible web sites. Do not use any payable libraries or websites, where you need to log in to view the articles, because I need to read and review the material. Please include the title of the article, author and link in the references).

Thank you.

Complete an environmental scan for the Bon Secours Health System.Use the SWOT Analysis table (attached) to complete the following:

?Assess the organization?s internal strengths and weaknesses.
?Analyze the industry for opportunities and threats.
?Perform a gap analysis. A SWOT analysis helps determine performance gaps. It includes the following components:
?Strengths
?Weaknesses
?Opportunities
?Threats
?Describe the organization?s present and prospective customers.
?Consider the following external factors:
?Consumer and social
?Competitive
?Technological
?Economic
?Legal and regulatory

Attach the SWOT analysis as a Microsoft? Excel? attachment.

Write a report in which you do the following:

?Explain why an environmental analysis is important in the development of a strategic plan by answering the following questions:
?What is the purpose of environmental analysis?
?What are the implications of environmental analysis in the creation of a strategic plan?
?What are the major benefits of competitive analysis as part of a strategic planning process?
?What evolving economic, legal, and regulatory issues may potentially have an effect on a strategic plan?
?Based on the SWOT analysis, provide an assessment of Bon Secours Health System in which the following is included:
?The organization?s ability to accomplish its mission, goals, and objectives as set in previous strategic plans
?The organization?s ability to respond to internal and external changes and challenges
?Incorporate the SWOT analysis findings into clearly stated goals and objectives for a 3- to 5-year period, focusing on the strategic plan areas.
?Provide two to three goals for each year, with two to three measurable objectives for each goal.
?Goals may span several years.
?Outline the goals and objectives clearly and provide a narrative explanation for each.

Provide a conclusion.

Overview
Community health nursing can improve access to care for the most vulnerable and hard-to-reach groups in any country. The community health nurse should combine knowledge of major indicators of health, social factors that contribute to declining health status, and public programs designed to address problems of health care. Efforts should encompass all levels of prevention (primary, secondary, tertiary) and should address the needs of the individual, family, aggregate, and community.
This assignment is 100 points, or 30% of your final grade.

Directions for the case study/final paper.
You are a community health nurse within your community and encounter a family of four that is homeless. They are recent documented immigrants (in the US via legal measures) and speak very little English. The adults possess a high school education, however are unemployed. The family consists of a 25 year old pregnant mother (5 months), her 27 year old husband who has a history of depression, their five year old son who should be starting kindergarten and was recently diagnosed with Type 1 diabetes, and a seventy-two year old grandmother who was recently diagnosed with COPD. They have no resources or family. Visit or interview representatives from various agencies to develop your responses. Please respond to the following:
A. Where do you refer them for shelter, food, clothing, and health care. Briefly describe the agencies and criteria required to obtain assistance. (10 points; 2 each)
B. What legal-ethical issues exist? (10 points; 5 each)
C. Identify local, state, and federal legislation applicable to this situation. (15 points; 5 each)
D. Apply an upstream perspective to design an evidence-based plan for health promotion and illness prevention for each member of the family. You must include the three levels of prevention in your plan. (60 points; 15 for each family member).
E. Utilize APA format and provide a reference list. (5 points)
Module #5 Final Assignment: Evolving local & global community health concerns

Local and state laws must refer to Cook County (Chicago) and the state laws are Illinois.
Websites can be used for references. Aunt Martha's (community service) should be used because they offer a lot of services that would apply to this family.

Please email me with any questions. This is a community/public health nursing class for a BSN program.

The paper will analyze a specific topic within the Affordable Care Act or The Future of Nursing. My topic is: PATIENT CENTERED MEDICAL HOMES.

1. Analyze patient centered medical homes and its impact on the health of U.S. citizens and the practice of advanced practice nurses.

2. Definition of the problem intended to be solved by legislation/policy

3. Description of the legislation/policy

4. Discuss the pros and cons of the legislation/policy

5. Personal views about the problem and legislation/policy

Application: Developing a Health Advocacy Campaign
To be an effective advocate and to develop a successful health advocacy campaign, you must have a clear idea of the goals of your campaign program and be able to communicate those goals to others. In addition, it is the nature of nurses to want to help, but it is important to make sure that the vision you develop is manageable in size and scope. By researching what others have done, you will better appreciate what can realistically be accomplished. It is also wise to determine if others have similar goals and to work with these people to form strategic partnerships. If you begin your planning with a strong idea of your resources, assets, and capabilities, you will be much more likely to succeed and truly make a difference with those you hope to help.
Over the next 3 weeks, you will develop a 9- to 12-page paper that outlines a health advocacy campaign designed to promote policies to improve the health of a population of your choice. This week, you will establish the framework for your campaign by identifying a population health concern of interest to you. You will then provide an overview of how you would approach advocating for this issue. In Week 9, you will consider legal and regulatory factors that have an impact on the issue and finally, in Week 10, you will identify ethical concerns that you could face as an advocate. Specific details for each aspect of this paper are provided each week. The Final Paper will be due in Week 10. This paper will serve as the Portfolio Application for the course.
Before you begin, review the complete Assignment.
This week, begin developing your health advocacy campaign by focusing on the following:
Identifying a Problem

To prepare:
Select a population health issue of interest to you and identify the population affected by the issue.
Locate two scholarly articles, each of which provides a description of an effective health advocacy program that addresses your issue.
Analyze the attributes of the programs to determine what made them effective.
Reflect on a policy you could propose or a change to a current policy to further improve the health of the population you selected with regard to the issue.
Consider how you could develop an advocacy program, applying the attributes identified in similar, effective programs.
To complete:
For this section of your paper (approximately 3??"4 pages in length) address the following:
Describe your selected population health issue and the population affected by this issue.
Summarize the advocacy programs you researched in this area.
Explain the attributes that made those programs effective.
Develop a plan for a health advocacy campaign that seeks to create a new policy or change an existing policy with regard to the issue and population you selected. Be sure to include in your plan:
o A description of the public health issue and proposed policy solution
o Specific objectives for the policy you want to be implemented
o The means by which you will convey information to various stakeholders on the need for this policy change
o Be sure your proposed need is substantiated by data and evidence.
o Methods of establishing support for the policy, including how to influence policymakers
Explain how the attributes of the effective advocacy programs you researched could be applied to your proposed advocacy campaign.
You do not need to submit anything this week. This Assignment is due by Day 7 of Week 10.



Application: Developing a Health Advocacy Campaign (continued): Legal Considerations
Last week, you began developing a health advocacy campaign for improving the health of a population through a change in policy. This week, you will continue by considering how laws and regulations can shape the way you advocate for and attempt to implement your proposed policy.
Before you begin, review the complete Assignment.
Legal Considerations
To prepare:
Review Chapter 3 of Health Policy and Politics: A Nurses Guide (3rd ed.) to determine methods of influencing the political process.
Reflect on whether the policy you would like to promote could best be achieved through the development of new legislation, or a change in an existing law or regulation.
Contemplate in what ways existing laws or regulations may impact how you proceed in advocating for your proposed policy.
Consider how you could influence legislators or other policymakers to enact the policy you would like to propose.
Think about the obstacles of the legislative process that may prevent your proposed policy from being implemented as intended.
To complete:
For this section of your paper (approximately 3??"4 pages in length) address the following:
Explain whether your proposed policy could be enacted through a modification of existing law or regulation or the creation of new legislation/regulation.
Explain how existing laws or regulations could impact your advocacy efforts.
Provide an analysis of the methods you could use to influence legislators or other policymakers to support your policy. In particular, explain how you would use the three legs of lobbying in your advocacy efforts.
Summarize the obstacles you anticipate arising in the legislative process and how you could overcome these hurdles.
This Assignment will be integrated into a Final Paper in Week 10. You do not need to submit anything this week. This Assignment is due by Day 7 of Week 10.



50 Chapter 3 Government Response: Legislation
also provide brief biographical information, photos, and other pertinent and background material.
Why is this important? Politics is at heart a people process and, like other centered endeavors, the relationships among and between people determine outcomes Nurses are well aware of how important communication and personal connection1 are in the care-giving context, and those same principles also affect the world of tics. Knowing a state representative and being able to recognize him or her on while also knowing something about the issues, are fundamental to producing
relationships. Just as nurses realize the importance of establishing good rapport clients, that same principle applies when establishing the connections needed to influence lawmakers.
In addition to knowing the people, one must also know the process-how laws made. Most nurses complete a government course in high school and promptly disregard most of the subject matter because it holds little relevance for them at the While diagrams depicting "How a Bill Becomes a Law" are important, they are very rudimentary (see Figure 3-1). There is much more to the process than can neatly depicted on a chart.
Bills are ideas that legislators have determined need to be ratified into law. ideas can come from many sources: the legislator's own experiences, the issues forward by constituents, or by special interest groups. Once the idea is drafted into the proper bill format, it is introduced into the House or Senate, depending on chamber to which the bill's chief sponsor belongs. (All budget bills are initiated in House, as it was designed to be most representative of the average citizens' Because of the importance of budgeting in regards to policymaking, it was given primary role in the budget process.) Once introduced, a bill is then referred to a standing committee for further consideration. These standing committees are related to health care go to a health committee, finance issues to a banking committee, farm-related matters to the agriculture committee, and so on. Standing committees can be configured differently over time and subcommittees may be named to consider particular bills in greater detail. Committee hearings are important, but they often appear to be more chaotic than productive. Much of the real business of law making is conducted behind the scenes, but one must also participate in the defined processes to earn a place at the more informal behind-the scenes-tables.
Committee chairs are extremely influential, particularly with respect to the subject matter areas that are the focus of the comittee's work. Chairs determine what bills will be heard and when, and they establish the procedural framework under which the committee operates. The chair's position on an issue can determine its fate from the outset. Because of the extent of their power and influence, committee chairs are able to raise large sums of money from special interest groups to support their re-election, and re-election is always an important consideration for lawmakers. House and Senate leadership (elected by their colleagues) determine who will be named as committee chairs. Certain committees are seen as more prestigious than others, so being named the chair of one of those committees is even more important to an ambitious legislator. Not surprisingly, political considerations play a role in this entire process. Being aware of the dynamics that are the foundation of the overall committee process helps ensure more effective representation by those who want to influence the outcome of the committee's work.
If a bill is able to garner committee approval, it goes to the full chamber for a vote. The timing for scheduling a vote, as well as various attempts to amend the bill or delay the vote, are all integral parts of the lawmaking process. Much maneuvering occurs backstage and the ability to influence these less public interactions is as important as the words or concepts being debated. Again, peoples' relationships and politics determine the ultimate results. To be able to be effective in one's efforts to influence outcomes, one must be aware of these relationships and take them into account. Once a bill is approved in either the House or Senate, it must begin the process again in the other chamber. The chief executive (president or governor) must sign the bill before it can become law and all of this must happen within a single legislative cycle-two years. It is not surprising that it often takes several years for a particular legislative issue to finally become law, especially when the issue is not one that garners a lot of public interest or attention. The state and federal processes each have special nuances, but the overall process is similar for both, as are the people dynamics that affect each step of the process.
Given all the hidden factors that affect success on Capitol Hill or in state legisla tures, how can an individual nurse hope to have sufficient knowledge or time to make a difference in the policymaking aspects of the profession? Fortunately, the American Nurses Association (ANA) and its state constituent associations, as well as specialty nursing groups, can provide their members with the tools they need to be successful. The success of these organizations' efforts in the legislative arena depends in large part on their members' involvement with and understanding the importance of an effective legislative presence on behalf of the profession in Washington, D.C., and in statehouses across the country. An individual nurse need only become a member of his/ her professional association and then take advantage of the resources provided by these organizations to be part of the cadre of politically-active nurses who are taking seriously the obligations set forth in the profession's social policy statement and its code of ethics. These organizations keep .nurses informed about what, why, and how things are happening, as well as help develop succinct messages to be conveyed to key lawmakers.
EFFECTIVE LOBBYING: A THREE-LEGGED STOOL
In addition to knowing the procedural aspects of lawmaking, nurses can also benefit from understanding the lesser known but equally important relational aspects of the process: the connections not depicted on any chart purporting to show how a bill becomes a law. Success in the legislative arena is much like a three-legged stool, with each leg essential to the sturdiness of the stool as a whole. The first leg is the formal lobbying effort provided by independent paid individuals, many of whom have close ties with elected and appointed officials. Leg number two is the grassroots leg, and the third leg is the political leg-the one that actively tries to influence the outcome of elections.
Leg One: Professional Lobbyists
No bill becomes law without lobbyists' input. Lobbying is the act of influencing-the art of persuading-a governmental entity to achieve a specific legislative or regulatory outcome. While anyone can lobby, lobbyists are most often individuals who represent special interest groups and are looked to as the experts by lawmakers who need information and rationale for supporting or not supporting a particular issue. The role of lobbyists has become even more critical as the complexity of legislation has increased; for example, the 1914law creating the Federal Trade Commission was a total of eight pages, the Social Security Act of 1935 totaled 28 pages, and the Financial Reform bill (conference version) of 2010 contained 2,319 pages (Brill, 2010). Legislators, often pressed for time, rely on lobbyists' expertise to help them understand what they are voting for or against.
According to the Center for Responsive Politics, there were 10,404 federal lobby- ists in 1998; in 2010, there were 12,488. While this number represents a decrease from a high of 14,869 in 2007,"the number of lobbyists has significantly increased over the years. In 1998, $1.44 billion was spent on lobbying; in 2010, the total was $2.61 billion, again down from $3.49 billion spent in 2009. Nevertheless, this represents a general increase overall. The American Nurses Association reported spending $1,197,342 on its lobbying efforts, utilizing the services of six lobbyists. The American Hospital Association, on the other hand, spent $13,585,000 and employed 72lobbyists, many of whom were categorized as "revolving door" lobbyists, or individuals who left positions in the legislative or regulatory arenas for typically more lucrative private sector employment. (The revolving door provides an entry and that are invaluable to a lobbyist and the special interests he/she represents. The more revolving door lobbyists an organization employs, the better connected it is to the inner workings of Capitol Hill.)
The willingness of entities to invest the level of resources associated with lobbying efforts is indicative of how important the connections forged by lobbyists are to the reputations of the interest groups, and to their ability to get the job done. Members of special interest groups expect legislative success, and that success comes with a price. Tellingly, it is a price many nurses are reluctant to embrace. Nurses must be more aware of the key role that lobbyists play and be willing to support the lobbying efforts of professional associations by becoming members of these organizations. Success in the halls of Congress and at statehouses is integral to the advancement of the profession itself and its societal values. Nurses want their legislative agenda advanced success- fully, and that expectation comes with a price tag that only nurses can pay.
Leg Two: Grassroots Lobbyists
While the paid lobbyists are the ones who most commonly come to mind when thinking of lobbying efforts, the so-called grassroots lobbying can be more effective if appropriately organized and informed. Grassroots lobbyists are constituents who have the power to elect officials through their vote. When constituents have expertise and knowledge about a particular issue (such as nurses in the healthcare reform debates), they are especially valuable resources for their elected officials. While issues debated in Washington, D.C., are national in scope, members of Congress are still concerned about how the issue is perceived back home. The connections established by a nurse constituent with his/her lawmakers at the federal, state, and local levels may provide timely access and a listening ear at key points during the policymaking process. To be effective, grassroots lobbyists must recognize that getting a law passed can take many years and entails compromise and commitment, along with an understanding of the political forces at work. In addition to employing paid lobbyists, professional nurse organizations have become increasingly aware of the strength of grassroots lobbying-seen by some as the most effective of all lobbying efforts (deVries & Vanderbilt, 1992).

The legislative process is an evolving one, founded on compromise. Settling for part of an initiative may be the best way to eventually achieve the entire goal. Willing- ness to persevere and keep returning to the legislature year after year, if necessary, is essential. New faces are chosen at each election and the volatility of the entire political arena can result in major philosophical changes in a relatively short time.

Leg Three: The Role of Money
The final leg of the stool is the one that causes much discomfort and concern to nurses and others: money. Politics in its most primitive form is on display when considering how money influences who wins or loses an election. The amount of money that flows to and through the legislative process has raised serious questions as to whether the whole process is "For Sale" to whoever has the deepest pockets. Unfortunately, winning an election or re-election, even at the local level, can be a very expensive proposition
costing millions of dollars. The total spending by political parties, candidates, and issue groups for the mid-term elections in 2010 is estimated to have exceeded $4 billion-a trend that is likely to continue in light of the recent United States Supreme Court decision in Citizens United v. Federal Election Commission (2010).
Not only has the amount of money flowing to campaigns increased dramatically, the source of those dollars (who has the deep pockets) has also changed and is expected to change even more in the future. For example, American Crossroads GPS (the brain- child of Republican strategists Karl Rove and Ed Gillespie, both of whom held influential staff positions under former President George W. Bush), American Action Network, Republican Governors Association, and the Chamber of Commerce are groups based in Washington, D.C., that financed state races across the country on behalf of Republican interests in 2010. On the Democratic side, organized labor, EMILY's List, and the League of Conservation Voters continue to contribute millions to fund campaign messages (Crowley, 2010). While these groups may appear to operate independently of each other, in actuality "coordination is as easy as walking across the hall" of their shared office space (p. 31). How this evolving dynamic will affect future elections and alliances remains to be seen, but its existence cannot be ignored or under estimated.

Application: Developing a Health Advocacy Campaign (continued): Ethical Considerations
This week, you will continue to work on the Assignment begun in Week 8 as you examine the ethical issues that may arise in advocating for the policy you selected.
Before you begin, review the complete Assignment. You will combine the sections of your paper developed in Weeks 8, 9, and 10 into one cogent paper due by Day 7 of this week.
To prepare for this final portion of your paper:
Review provisions 7, 8, and 9 of the ANA Code of Ethics in relation to advocacy for population health.
Reflect on the ethical considerations you may need to take into account in your advocacy campaign.
Research the ethical considerations, laws, and reporting requirements (with respect to lobbying) that are relevant to the location where your advocacy campaign will occur.
Consider potential ethical dilemmas you might face in your campaign.
To complete:
For this section of your paper (approximately 3??"4 pages in length), address the following:
Explain any ethical dilemmas that could arise during your advocacy campaign, and how you would resolve them.
Describe the ethics laws and reporting requirements that are applicable to your advocacy campaign.
Evaluate the special ethical challenges that are unique to the population you are addressing.
Reminder: You will combine the sections of your paper developed in Weeks 8, 9, and 10 into one cogent paper.
Due by Day 7 of this week.


2001 Approved provisions

The ANA House of Delegates approved these nine provisions of the new Code of Ethics for Nurses at its June 30, 2001 meeting in Washington, DC. In July, 2001, the Congress of Nursing Practice and Economics voted to accept the new language of the interpretive statements resulting in a fully approved revised Code of Ethics for Nurses With Interpretive Statements.
1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.
2. The nurse's primary commitment is to the patient, whether an individual, family, group, or community.
3. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.
4. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care.
5. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.
6. The nurse participates in establishing, maintaining, and improving healthcare environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.
7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.
8. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.
9. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.
American Nurses Association, Code of Ethics for Nurses with Interpretive Statements, 2001 By American Nurses Association. Reprinted with Permission. All rights reserved.



Please add headings to the different sections, and also include an introductory paragraph and a conclusion.










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