Health Care Policy and Reflection Paper

Health Care Policy and Reflection Paper

Health Care Policy and Reflection Paper

Abstract

Gun violence is a nationwide public health epidemic that not only leaves a significant toll on U.S. society but also on other countries around the globe. Racial minorities, especially Black Americans, have been disproportionally affected by gun violence and have the highest gun-related injuries and mortalities than Whites. Findings from the literature review show that gun violence can be mitigated through designing the environment and implementing approaches specific to the high crime areas. Remediating blighted vacant urban land is also an established approach to lowering gun shootings in areas prone to gun violence. Strict firearm laws like the Brady Act and age restrictions have also reduced the incidence of gun violence in states with such laws. The paper recommends various interventions in the healthcare delivery system to reduce gun violence, including screening women for intimate partner violence and referring those found positive to facilities where they can get social help services. It also recommends counseling of patients by healthcare providers on the consequences of having firearms at home. This is thought to reduce gun homicides among adolescents and persons with mental disorders, including dementia, substance abuse, and suicide. 

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Health Care Policy and Reflection Paper

Contemporary Issue in Health Care Policy

Gun violence and racism are contemporary issues in health care policy and a public health crisis in the United States (US). Gun violence is perpetrated using firearms, such as shotguns, pistols, assault rifles, and machine guns. The Centers for Disease Control and Prevention (CDC) (2021) statistics show that there were approximately 45,222 deaths from firearms in the US in 2020, which is 13.7 deaths per 100,000 population. The states with the highest gun-violence deaths were Texas, California, and Florida, with 4164, 3449, and 3041 deaths, respectively. Rhode Island and Hawaii had the least gun deaths, with 54 and 50 reported deaths (CDC, 2021). However, the states with the highest death rate were Mississippi, Louisiana, and Wyoming, with 28.6, 26.3, and 25.9 per 100,000. Although gun violence is a general American threat, the minority racial populations are the most affected. Gun violence in the US reflects and worsens racial inequities. The high number of firearm-related injuries and deaths in the US disproportionately affects individuals of racial and ethnic minorities, especially African Americans. Black Americans are ten times more likely than Whites to die from gun violence and almost three times more likely to experience fatal police shootings than white Americans, with Black youths being the most targeted (Swanson, 2020). Besides, Black children and teenagers are 14 times more prone to die from gun shootings than their White peers. As a result, gun violence reduces the life expectancy of Black Americans by roughly four years. It is worth noting that gun assaults, homicides, and police shootings are disproportionately rampant in historically underfunded neighborhoods and cities (Swanson, 2020). Gun violence clusters in particular social networks and neighborhood sub-sections. The inadequate funding intensifies the long-standing racial inequities in the US.

Relevance to Advanced Practice Nursing

Gun violence is relevant to APN since it affects individuals of all ages and races. APNs care for victims of gun violence and their families daily. Gunshot injuries are usually life-changing and permanently affect the victims’ long-term physical and mental health (Swanson, 2020). APNs are forced to provide victims of gunshot injuries with permanent, lifelong care, while many lose their capacity to work, especially in physically demanding jobs. Despite this impact, the country lack programs that provide adequate long-term care, rehabilitation, and job retraining to gun violence victims. Furthermore, the undesirable consequences of gun violence on victims, their family members, and the healthcare system have led to a chronic public health crisis with peculiarly little government response. Other than the thousands of individuals injured and killed through gun violence, numerous families must handle the financial consequences of the violence (Swanson, 2020). It is generally estimated that gun violence expenses, including medical charges, daily care/support, loss of income, and criminal justice expenses cost the U.S. economy roughly $229 billion yearly.

Evidence-Based Literature

Gun violence should be regarded as a public health issue. It is a public health epidemic that requires to be addressed with research and evidence-based strategies that can lower the associated morbidity and mortality. Blais (2019) discusses gun violence prevention through environmental design or place-based approaches. The article argues that handling the question of areas with high rates of gun violence facilitates a change in the debate from firearm control to the prevention of gun-related violence by place management. Proper management of areas with a high prevalence of gun violence is a promising initiative to mitigate gun violence in the country. In addition, Blais (2019) discusses that various initiatives such as problem-oriented policing, hot-spot policing, and situational crime prevention programs are effective in reducing violence in neighborhoods with rampant gun violence, contrary to gun control laws.

Moyer et al. (2019) conducted a study to establish if remediating blighted vacant urban land lowered gun shooting incidents causing injury or death. The study found that remediating vacant land with cheap, scalable interventions, like greening or minimal mowing and trash cleanup, markedly decreased shootings causing serious injury or death. The public health implication is that towns should try out place-based approaches to develop effective gun violence–reduction strategies. The article explains that the concept of high-crime areas is entrenched in the environmental criminology paradigm. The article argues that employing interventions in high-crime neighborhoods, towns, and cities might be more appropriate than gun control projects. Violence can be imagined as pollution, and regulations are needed to lower it. Thus, regulations to prevent gun violence can include means such as mandates to maintain private lands and ends like fines for property holders whose lands surpass the maximum number of calls to police.

Jehan et al. (2018) conducted a study to establish the relationship between gun legislation and gun-related injuries across states in the US. The study found that states with strict firearm laws (SFL) had significantly lower incidences of gun violence-related hospital admissions and mortality than states with non-strict firearm laws (non-SFL) across the US. It further established that a high number of state gun legislation were connected with a low incidence of firearm-related homicide and suicide rates. One of the gun regulations in the US is the Brady Act, which requires the Federal Bureau of Investigation (FBI) and state agencies to conduct criminal history background checks on individuals who want to buy a firearm from a licensed dealer.

Jehan et al. (2018) identified that the Brady Act decreased suicide rates among individuals 55 years and older, but there was no change in the overall suicide or homicide rates. Likewise, the age limit of 21 years for buying a handgun did not lower the gun-related homicide or suicide rates. The study found that conducting local-level background checks on individuals before buying guns was connected with a 27% lower gun suicide rate and a reduction in homicide rate by 22%. Restrictions on firearms purchase in states lowered the suicide rates. Furthermore, laws on safe gun practices such as keeping guns unloaded and ammunition locked at various locations have been demonstrated to reduce firearm-related injuries.

Raifman et al. (2020) examined the relationship between US state policies that outline the age of 18 or 21 years as the minimum buyer age for the sale of firearms and the adolescent suicide rate. The study found an obvious discontinuity in the adolescent suicide rate at age 18 in states that restricted the sale of firearms to persons aged 18 or older. Besides, state policies that limited the sale of guns to persons aged 21 or older were linked to a decrease in adolescent suicide rates. However, increased suicide rates were noted after states lowered the age of gun sales, but there was no effect in states that increased the age of gun sales.

The American College of Physicians (ACP) released its position statements and recommendations on decreasing gun-related injuries and deaths in the US. The ACP recommends a public health approach to gun-related violence and the prevention of gun injuries and deaths. It supports the creation of coalitions that offer various perspectives on the gun issue (Butkus et al., 2018). ACP recommends physicians to counsel patients on the risk of having guns at home, especially when children, adolescents, and persons with dementia, mental disorders, or substance use disorders are present. Besides, ACP recommends that State and federal authorities refrain from enacting mandates that hinder physician free speech and the physician-patient relationship. It encourages physicians to discuss with their patients the risks associated with having a firearm in the home and recommend ways to mitigate such risks, including best practices to reduce injuries and deaths (Butkus et al., 2018). Furthermore, the ACP states that physicians should be well-versed in gun injury prevention. It recommends medical schools, residency programs, and CME programs incorporate gun violence prevention into their curricula.

Recommendations for Improvements in the Health Care Delivery System

The complexity and prevalence of gun violence, in addition to its negative effect on the health and safety of Americans, imply that a public health intervention should be a major approach that should be employed to prevent future gun-related harm, injuries, and deaths. Based on the above literature review, I would recommend various improvements in the healthcare delivery system to reduce gun violence. Intimate partner violence (IPV) has been associated with gun-related deaths, with women having the highest prevalence of IPV-related homicide (Miller & McCaw, 2019). Regarding this, I would recommend screening all women for IPV and referring those who are found positive for a history of IPV to intervention services. IPV victims are at high risk for possible gun violence. Health providers should be encouraged to refer female clients following a positive assessment for IPV to organizations that provide resources for crisis intervention and counseling (Miller & McCaw, 2019). They should also help them find medical care, safe housing, and legal advocacy.

            Healthcare providers have a crucial role in counseling clients about preventing gun-related injuries, including safe storage practices. Therefore, I recommend that health providers counsel patients in every patient care setting to raise awareness for at-risk patients, especially adolescent patients and persons with suicidal ideation. I would recommend health providers contest the state “gag rule” bills that seek to discourage this crucial doctor-patient communication. In addition, I recommend that providers counsel patients and their family members to avoid having guns at home, especially where there are children, adolescents, dementia patients, or members with mental disorders, substance use disorders, or a history of suicidal attempts. Besides, providers should recommend to the patients of approaches to alleviating risks of gun homicide and the best practices to decrease gun-related injuries and deaths at home.

APN Competencies Related To Gun Violence and Racism

The nurse practitioner (NP) competencies associated with gun violence and racism are expert coaching and advice, consultation, clinical and professional leadership, research skills, and collaboration. The NP should demonstrate expert coaching and guidance through knowledge and expertise on risks associated with firearms and approaches to reduce gun violence (Moore & Hawkins-Walsh, 2020). The NP should develop evidence-based educational interventions for patients and their families on the prevention of gun violence and exhibit the capacity to apply adult teaching principles. Under the competence of consultation, the NP should apply the specialties of other disciplines like social work, psychology, and medicine to develop and tailor a comprehensive patient teaching plan to prevent gun violence (Moore & Hawkins-Walsh, 2020). In addition, the NP should demonstrate clinical and professional leadership competence by interacting with other healthcare center providers to implement the teaching plan, as well as be a role model and provide feedback to the team as needed.

The NP can demonstrate the research skills competence by participating in a research study on interventions that can reduce gun violence among the population they serve. The NP should know the aims and purpose of the research study, collaborate with the research team, assist in developing the evidence-based intervention plan, implement the plan, and maintain the client relationship as per the study’s goals (Moore & Hawkins-Walsh, 2020). Besides, the NP should use evidence-based literature in developing a tailored education plan on gun violence to benefit the patient. Lastly, the NP can exhibit collaboration competence by partnering with other health care team providers to educate patients on interventions to reduce gun violence.

Conclusion

Gun violence comprises violent crime, homicide, attempted suicide, suicide, and unintentional death and injury. Black Americans in the US are disproportionately affected by gun violence, evidenced by the high percentage of firearm-related injuries and deaths in this population. The healthcare providers who witness the extensive impact gun-related violence has on the health of patients, families, and communities influence to improve the safety and wellbeing of these groups. I recommend screening for Intimate partner violence, counseling patients to raise awareness of the risks of gun violence, and providers educating patients and their families on interventions to alleviate risks of gun homicide at home. The APN competencies relating to gun violence prevention include expert coaching and advice, consultation, clinical and professional leadership, research skills, and collaboration.

References

Blais, E. (2019). Focusing on Places Rather Than Guns. American Journal of public health, 109(1), 25–26. https://doi.org/10.2105/AJPH.2018.304827

Butkus, R., Doherty, R., Bornstein, S. S., & Health and Public Policy Committee of the American College of Physicians*. (2018). Reducing firearm injuries and deaths in the United States: a position paper from the American College of Physicians. Annals of internal medicine, 169(10), 704-707. https://doi.org/10.7326/M18-1530

Centers for Disease Control and Prevention. (2021, March 1). FastStats. https://www.cdc.gov/nchs/fastats/suicide.htm

Jehan, F., Pandit, V., O’Keeffe, T., Azim, A., Jain, A., A Tai, S., Tang, A., Khan, M., Kulvatunyou, N., Gries, L., & Joseph, B. (2018). The burden of firearm violence in the United States: stricter laws result in safer states. Journal of injury & violence research, 10(1), 11–16. https://doi.org/10.5249/jivr.v10i1.951

Miller, E., & McCaw, B. (2019). Intimate partner violence. New England Journal of Medicine, 380(9), 850-857. https://doi.org/10.1056/NEJMra1807166

Moore, J., & Hawkins-Walsh, E. (2020). Evaluating Nurse Practitioner Student Competencies: Application of Entrustable Professional Activities. The Journal of nursing education, 59(12), 714–720. https://doi.org/10.3928/01484834-20201118-11

Moyer, R., MacDonald, J. M., Ridgeway, G., & Branas, C. C. (2019). Effect of Remediating Blighted Vacant Land on Shootings: A Citywide Cluster Randomized Trial. American Journal of public health, 109(1), 140–144. https://doi.org/10.2105/AJPH.2018.304752

Raifman, J., Larson, E., Barry, C. L., Siegel, M., Ulrich, M., Knopov, A., & Galea, S. (2020). State handgun purchase age minimums in the US and adolescent suicide rates: regression discontinuity and difference-in-differences analyses. BMJ (Clinical research ed.), 370, m2436. https://doi.org/10.1136/bmj.m2436

Swanson, J. W. (2020). The color of risk protection orders: gun violence, gun laws, and racial justice. Injury Epidemiology, 7(1), 1-6. https://doi.org/10.1186/s40621-020-00272-z

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Identify a contemporary issue in health care policy and its relevance to advanced practice
nursing.
ï‚· Conduct a search of appropriate evidence-based literature
ï‚· Utilize research to recommend improvements in the health care delivery system.
ï‚· Reflect upon the APN competencies related to that issue
8 pages

ETHICS AND PUBLIC POLICY IN THE HEALTH CARE DELIVERY SYSTEM

SUMMER 2022

Health Care Policy and Reflection Paper & Grading Criteria

            Purpose:

The purpose of this assignment is for the student to demonstrate an ability to:

·         Identify a contemporary issue in health care policy and its relevance to advanced practice nursing (gun violence and racism are a public health crisis in America and how it relates to nursing)

·         Conduct a search of appropriate evidence-based literature

• Utilize research to recommend improvements in the health care delivery system.

·         Reflect upon the APN competencies related to that issue

            Guidelines:

• Student will conduct a literature search and identify at least five recent (within 5 years) articles from peer-reviewed journals that provide information related to the identified issue
• Student will prepare a well-worded paper which integrates the information learned from conducting the literature search and summarizes reflection of personal and professional responsibilities related to the issue including the impact on the APN competencies of your chosen track
• Assignment is to be typed and presented in APA format which includes a title page (identifying the student’s name, course information, date) an abstract page, the body of the paper, and reference page (listing all resources utilized making sure to cite within the body of the paper where those resources were utilized) Total components of the Research Paper to be at least eight (8) pages.
• Grading rubric for this assignment is as follows:

APA Format

Paper must be formatted in APA style to include: ·         Title page (name, course information, date, running head information) ·         Abstract (appears on new page, provides a concise summary of the key points of the paper, single paragraph, double-spaced consists of 150-200 words ·         Body of the paper is all double-spaced with professional language throughout, includes page numbers and running head ·         Paper is organized with correct spelling & grammar ·         Paper to include proper headings in the proper format ·         Total paper to be at least eight (8) pages ·         In-text citations used for all paraphrased material and page # and quotations are used for direct quotes ·         Reference page is thorough and properly formatted (each source cited in the paper must appear on the reference list and all entries on the reference list must be cited within the body of the paper