Global Health Trends and Policy and Politics

Policy, Politics and Global Trends in Health Sector

Why the Public Policy Issue Was Chosen?

According to the report released by National Priorities and Goals -- aligning efforts meant to transform America's Health care (NQF, 2009; Partnership, 2008). NPP (National Priorities Partnership) came up with 6 priorities. If the priorities are addressed, it could improve the quality of health care delivered to the U.S. citizens. NPP consists of 48 major U.S. health care organizations, which work with NQF (National Quality Forum). It identifies and advances priorities geared at improving health care in the future (NQF, 2009). NPP has identified palliative care as one of the six priorities that can help improve patient-based utilization outcome. This article provides the background to help identify steps to assist match the medical treatment of the patient and family objectives. It concerns itself with access to quality hospice services and palliative care (Meier, 2011). This policy looks at the part of palliative care that can be incorporated into the United States of America's health care system.

1. It enhances the value of health care

The value in health care refers to the ratio of quality to cost. The value can be improved by reducing the cost and also improving the quality. People who have multiple functional impairment and chronic conditions constitute10% of the patients in the U.S. It accounts for more than half of the cost of health care (Office of the Assistant Secretaryfor Planning and Evaluation, U.S. Department of Health and Human Services, and The Lewin Group, 2010). Palliative care that targets the patients in hospitals are evolving (Goldsmith, Dietrich, Du & Morrison, 2008). As a result, they have increased both their value by reducing the cost of care for those who are sick and those suffering from complex problems. Hospices that are certified as Medicare serve over 1.5 million dying Americans every year. From this discussion, it is evident that hospice programs and Palliative care are crucial to improving the health care value through the ability to improve the quality of care and reduce the cost the health care system faces.

2. Improving the Quality of Care

Palliative care and hospice programs are meant to improve the psychological and physical symptoms of patients and, family caregivers. It is also meant to improve the bereavement outcome and ensure physical satisfaction.

These goals can be achieved through the care provided by the nurses, social workers, spiritual counselors' psychologists, aids, pharmacists and physicians. In such cases, palliative care and hospice teams are charged with the responsibility of establishing goals and plans for safe transitions out of health units and support families in crisis.

Proper communication on the patient's prognosis and the goals by all the teams ensure better decision making and guarantees consistent follow up. Discussions at a family level lower the cost and reduce the burden on the family (Wright, et al., 2010). It also reduces dissatisfaction and improves bereavement outcome. According to the recent studies, it has been demonstrated that both palliative and hospice care are associated with a significant prolongation of the patient's life (Bakitas, et al., 2009) (Connor, Pyenson, Fitch, Spence, & Iwasaki, 2007).

Relevance of the Public Policy Issue to the Nursing or Health Profession

An audit at the national hospital deaths revealed that 25% of patients could not have lost their lives at home, if community resources were in place. However, without hospice beds or support, many families have little choices, even when the patient's condition deteriorates (Hospice Friendly Hospital programs 2010). Ultimately, these impacts heavily on emergency departments, bed utilization, trolley waits usage as well as discharge rates.

For instance, Milford Care Center has been able to reduce death rates by 6%. In the same breadth, nationally, palliative care has been able to reduce the proportions of death in hospitals from 43% to 21%. According to studies conducted in the U.S., Canada and Spain, it demonstrated that Palliative care had a positive impact on the cost of acute care (Irish Hospice Foundation, 2014). In effect, it has been able to increase the deaths occurring at home from 26% to 42%. This shows that there is a positive impact of development of palliative care programs. This means that the policy will benefit health care and nurses by reducing the costs associated with staying in hospitals.

The Financial Impact of the Policy to the Community or Organization

According to recent statistics (Morrison et al., 2008), palliative care has helped save $2,659. In the U.S., 2% of the 30 million people who are hospitalized die (AHRQ, 2002). This number includes the 4% of patients who are discharged because of chronic illness, but who may benefit from the care services. According to the 2009 data, all U.S. hospitals with more than 50 beds have established palliative care centers (Goldsmith, Dietrich, Du, & Morrison, 2008). The centers affect more than 1.5% of all the discharges and are estimated to save over $1.2 billion annually.

The Impact of My Values on Public Policy Issue

Care is considered the greatest value both in personal life and in field. Hospital palliative services have become more significant since they provide the much needed care, even when medicine cannot provide the desired cure. Patients deserve quality health care during the time of illness. It is meant to meet the needs of the dying patients, thus hospitals are under an obligation to offer such programs in pursuance to the principles of non-maleficence and beneficence. Clinicians must always relieve pain and improve the quality of life of their patients to the best of their abilities (Paulus, 2008).

The Ethics and the Principles of the Perspective

The theory ethics of care places more significance in the elements of relationship and human life dependencies. It seeks to maintain a relationship by promoting caregivers and care receivers' well-being. It entails meeting your needs and those of other people. It is anchored on the motivation to care for the vulnerable or those who are dependent. Thus, care ethics affirms the importance of caring, moral deliberation as well as reasoning (Sander-Staudt, 2015).

Importance of Decision Making in Public Policy Issue

Hospices are better placed to provide improved symptom management compared to the cure-based care. Patients, who have access to hospice care lead an improved life, don't suffer from depressions and associated symptom issues. They are less exposed to risks that lead to hospitalization and incur reduced costs from utilization of health care facilities and resources.

The benefits are also extended to friends, caregivers and family who are always satisfied with the quality of care given.

According to research published in the journal of American Medical Association (Obermeyer et al., 2014), hospice care is important to cancer patients since they are less likely to be hospitalized or admitted in ICU or undergo invasive procedures. This study was conducted on 40,000 cancer patients who died in 2011. The study concluded that health care costs are reduced by $9,000 per hospice patient. In addition, almost seventy-five percent of non- hospice patients died in nursing homes or hospitals compared to the fourteen percent of the hospice patients. According to the study, there is need for physicians and patients to discuss the importance of the palliative care (Brikman, 2014). All said, it is clear that hospice and palliative care has not made inroads in the healthcare settings. Consequently, there is need for the policymakers to realize the importance of the policy to avail the care to those who need it.

Challenges of Addressing the Chosen Public Policy Issue

One of the main challenges of receiving hospice and palliative care include: access, inadequate workforce, lack of research evidence that can be used as a guide and a measure of care as well as lack of knowledge on the benefits of hospice and palliative care.

Access to Hospice and Palliative Care

Palliative care has only been available to patients in hospice programs (National Consensus Project for Quality Palliative Care, 2004). Fortunately, there are many hospitals that provide palliative care programs, which take care of the seriously ill patients and those waiting to die. More than 62% of U.S. hospitals with 50 beds and 84% of hospitals with over 300 beds have been reported to have the palliative care programs. However, in the U.S., access to hospice programs and palliative care is highly variable. In the south, the profit hospitals with less than 100 beds are not likely to have palliative care programs ((American Hospital Association, 2009; CAPC, 2010). This is not the case for the not-for profit hospitals outside the south. In settings in which palliative care is available, there is still a great deal of variability, and patients have access to half the time of nurses as well as full time interdisciplinary palliative care experts. Even though, it is important to note that the presence of palliative centers that are adequately staffed may not guarantee full access to palliative care services.

Workforce

Lack of medical and nursing workforce experienced in palliative care is one of the barriers to accessing palliative care services. In the past few days, the number of palliative medicine specialists has experienced significant shortfalls (Salseberg, 2002). This calls for a policy whose objective is to increase education and training in palliative care for clinics serving patients faced with serious illness. The focus should be to increase the funding so as to increase and attract the number of physicians in this field. It also calls for examining the role played by physicians, nurses, and social workers so as to strengthen access to palliative care. It is estimated that the shortfall consists of 2,787 full time physicians. This has impacted negatively on the hospice community. The rise in the number of patients served by the program has in the mean time outstripped the rate of growth of the trained personnel. The requirement that each patient be visited so as to recertify their prognostic eligibility for hospice services cannot be met (Meier, 2011).

Insufficient Research on Palliative Care and Hospice

Investment in research in hospice and palliative care is required to ensure that any care provided is based on evidence. Meanwhile, the U.S. has a higher aging population and people with multiple chronic condition and impairments, accounting for most of the spending in the health care sector.

Non-profit and charitable organizations do not invest in research, meaning that the federal must find sources of money to fill the gaps.

Investment in research in palliative care is necessary since it ensures that any care given is based on the evidence and delivery models. It is true that most of the U.S. population is aging and comprise of persons who have multiple chronic conditions and impairments, constituting the bulk of its health care spending (Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, and The Lewin Group, 2010). One of the latest studies on the same revealed that less than 0.01 NIH extramural funding was allocated to palliative care research between 2003 and 2005 (Gelfman & Morrison, 2008). In very rare occasions does nonprofit and charitable foundations invest in research, thus placing pressure on the federal funding to undertake all the investments (NPCRC, 2010).

Confusion

The confusion between the hospice and palliative care in terms of scope and intent makes many people think that the centers cater for patients with terminal malignant, such as cancer and that such services should only be administered in hospice centers. This has affected the program. Also, concerns about compromised access to expensive life prolonging treatments, such as transfusions, radiation, and hyper alimentation, are scaring (Finestone, 2008).

Mistrust and perception that hospice centers are economically motivated

Prognostic Uncertainty

Psychological issues where patients and physicians have a bias towards optimism affect the programs (Christakis & Lamont, 2000).

Decision Making Intervention and Why They Are Tangible

By making the referral process easy, referring clinicians are always worried that the patient may think that they have given up when they recommend them to palliative care. Here is one of the ways the clinicians can introduce the palliative care.

"We have been managing your condition for quite some time, but I want to ensure that we do everything possible so that you get assisted. The palliative and hospice care team are better placed to ensure that the symptoms are well controlled and that there is the extra support you and your family need."

Importance

Helps to build collaborative relationship through joint visits. Cardiologists can use this opportunity to gain more knowledge in palliative care consultation. It helps them understand the patient and develop strategies to help them lead a meaningful life, even in the face of serious illness (Lindvall, Hultman, & Jackson, 2014).

Can be used to clarify that decisions can be made by the local hospice program in conjunction with the family members or the patients themselves.

Help the patient understand that the cost of hospice can be equated to that of the usual care.

Can be used as an opportunity to educate the physicians on the illness trajectories and other admission guidelines.

It helps to contextualize decisions by discussing various aspects, such as care planning, through routine office visits (Mcateer & Wellbery 2013).

Cause of Action for the Decision Maker and Approaches that Can Help them Avoid Challenges

According to studies, nurses are being encouraged to lead the effort of integrating palliative care with that of those who are critically ill by identifying the barriers and using the critical care nurses to overcome such barriers. This is meant to enhance the patient's outcome and reduce their suffering. Nurses should be involved because they experience the stress associated with end of life decision making (Arlotta, 2015). Note that before all this is considered, there should be a solid foundation regarding funding, policy issues, management role, how palliative care and the normal curative care relate, and how to overcome any of the challenges identified.

Relevant stakeholders, such as ANA (American Nurses Association), and HPNA (Hospice and (Palliative Nurses Association) should be communicated in advance so that their input can be incorporated in the implementation of the policy. The decision maker must show some level of commitment so that the policy does not end up on the shelves.

Top --Down Approach (Evaluating the Success of the Policy)

This is a clear cut system of control that showcases (1) and which, aims at ensuring that the goals are achieved as articulated in the policy, (2) knowledge of the cause and the effects, (3) hierarchy of the authority, (4) alignment with the established rules and (5) capacity and the resources to implement commands. After all this, it should be capable of evaluating the success of the brief. The responsible agency must also work hard to achieve some level of success. If all this happens, then the policy is said to have succeeded. This is the point at which implementation begins, and the population can start reaping the benefits from the policy. The top down approach is an essential element in the planning. It is in line with the tenets of overhead democray where authority is delegated from by the elected official to the civil servants, accountable to the elected officials (Political Pipeline, 2013).

Community or Organization with Expressed Interest in the Public Policy

HPNA (The Hospice and Palliative Nurses Association) and ANA (American Nurses Association) are the leading organizations that advocate for the policy.

Evidence Why Community or Organizations are interested in the Policy Issues

ANA and HPNA have partnered to integrate the palliative and hospice care into the U.S. health care system. The effect of this effort includes joint HPNA-ANA position statement, and the tool kit or references that identify nursing contributions in the hospice and palliative care. They identify and come up with a framework that is needed in nursing practice, and at the same time, promote and enhance access to use of Hospice and palliative care (ANA, 2015).

CBPR Community or Organization Principles that can be Used by the Community to Address a Policy Change

Developing a strong partnership with the community is important in helping create a relationship and research initiative relevant to the patient. Consequently, the following CBPR principles are important in the partnership. It helps to:

Build and strengthen the resources in the community

Facilitate collaboration in the research

Integrate the actions and the exiting knowledge to benefit all partners

Address health matters from both ecological and positive perspective.

Disseminates the knowledge and findings to partners (Hartwig, Calleson, & Williams, 2006).

Approaches to Collaboration with the Community and Organization

The easiest way to collaborate with ANA and HPNA requires that you meet the following general procedures:

Fill the application and submit it to ANA

ANA will review the application

The application is then forwarded to ANA Board of Directors for approval. The board meets every month to approve the process.

After ANA have taken a decision, its staff notifies the applicant whereupon the orientation date is set (ANA, 2008).

Aligning the Community or the Organizations Goal with Your Goal

ANA is lobbying regulatory agencies and the Congress on health issues that affect the nurses and the public. Through its legislative program, it is lobbying and greatly contributing to the reform in the health care sector at the National level and the state level (ANA, 2015). Although ANA goals are anchored on two primary goals: care for health issues that affects the public and Palliative care.

Steps To Take To Help You Achieve Your Goals

Identify policy issues in palliative care

Identify the goal to be achieved

Identify partners and organizations with similar goals

Develop suitable solutions that can be used to remedy the issues identified

Recommend policies to the deserving recipients.

The Role and the Responsibility of the Organization or the Community Members

A logical and consistent program of study that incorporates cross discipline research and studies focused on capacity building

Availing sufficient infrastructural support and resource

Creating a common platform for defining the extent of the policies and the introduction of fresh partnerships

Facilitate a common forum for the organizations to tackle policy matters at both local and international levels (Matthews, 2012).

Elements of Developing a Collaborative and Evaluation of Plan Based on Care Principles

Effective Communication

This is a key element of human interaction. It is the ability to communicate in a high intensity health care environment. It does not just entail a transaction of words, but include appreciation of the tone, emotions and the accuracy of the information. When it is consistently implemented, it can bridge the figurative divide and ensure that there is a dynamic method that can be used to relay feedback and information.