Community Nursing – Discussion Questions

Community Nursing – Discussion Questions

Community Nursing – Discussion Questions

Community Nursing – Discussion Questions

Review the attached PowerPoints presentations. Once done answer the following questions:

1. Do you feel it is better to allow individuals the freedom to choose any type of  (or no) health insurance coverage available to them or to increase government involvement in a person’s/family’s healthcare via mandates, such as the ACA and/or the government as a single insurer for all residents.  Why?

2. Discuss the mission of the Patient-Centered Outcomes Research Institute (PCORI) and the Center for Medicare & Medicaid Innovation (CMMI).


3.If you could reform the malpractice or tort laws, what types of changes would you make? When do you feel it is appropriate for someone to claim damages from medical procedures or treatment? Do you feel there should be a cap on the payments, and if so, how would you decide what that cap would be? What are all the different costs involved in medical malpractice suites? Is it easier to talk about tort reform than to actually try to define it?

4.  The rights of people once they have been incarcerated can be a controversial topic of discussion. Discuss the healthcare rights of the incarcerated population. What do you feel should or should not be provided to those who are imprisoned? Are there certain tests or procedures that they feel should be performed routinely? Why or why not? What is the nurse’s role, based on the section on page 248?

– APA format word document, Arial 12 font.

– A minimum of 3 evidence-based references no older than 5 years  (excluding the class textbook) are required.

– A minimum of 600 words are required (excluding first and last page).

From now on discussion questions will have a rubric.

Community Nursing – Discussion Questions

Chapter 8
Economics of Health Care
Economic Approach to Health Care
Competition in the market

–Healthcare market




Competition Versus Regulation
Standards of participation
Cost containment and value
Market Failure in Health Care
Free market competition
Market failure
Supplier-influenced demand
Third-party payer
Imperfect market
Rising Costs and Today’s Healthcare System
Social Security Act of 1935
1959 Federal Employees Health Benefit Act and Blue Cross
1960’s Medicaid (Title XIX) and Medicare (Title XVIII)
Increased costs

–Gross domestic product (GDP)

Rising Costs and Today’s Healthcare System (cont.)
Decreased access

–Rising costs/inability to pay

–Increased number of people covered by Medicare and Medicaid; decreased number covered by private insurance

–More employers offering insurance; fewer employees are purchasing it

–Private insurance does not guarantee financial access to care

–Public programs offer inadequate prenatal and mental health care programs

–Negative outcomes for the uninsured/underinsured

Rising Costs and Today’s Healthcare System (cont.)
Influences on costs and access

–Increased sources of funds from governments


–Drug cost increase

–Advanced technology is expensive

–Higher personnel wages and benefits costs

–Change in population demographics


–Medical excess

–Administrative excess

–Emphasis on cure instead of prevention

Paying for Health Care
Out-of-pocket payments and charity

–Cost sharing

Health insurance

–Private insurance

–Employment-based insurance

Experience rating
Community rating

–Health insurance purchasing cooperatives


Paying for Health Care (cont.)
Publicly funded insurance and direct care programs


Part A

–Inpatient hospital care

»Benefit period

–Skilled nursing facility

–Home health agency


Part B and Part D
Medicare Advantage
“Medigap” insurance
Paying for Health Care (cont.)


Entitlement/welfare program
Based on income and assets
Categorically needy
Medically needy
Personal Responsibility and Work Opportunity Act

–Temporary Assistance for Needy Families (TANF)

Paying for Health Care (cont.)

–Children’s Health Insurance Program (CHIP)

Federally funded


–Other public direct care programs:

Public Health Service Act of 1994
Affordable Care Act (ACA) of 2010
Cost Containment, Cost Analysis, and Quality
Cost-containment strategies

–Controlling quantity of supply

–Controlling price

–Controlling quantity of demand


–Prioritizing through cost analysis

Cost Containment, Cost Analysis, and Quality (cont.)
Cost analysis

–Cost-of-illness analysis

–Cost–benefit analysis

–Cost-effectiveness analysis

–Technology assessment

Public Health, Managed Care, and the Economics of Prevention
Opportunities for collaboration

–Cost-containment efforts

–Shift from acute services to preventive

Counterforces to collaboration

–Safety net

–Dumping of services

–Coordination of state reporting

–Nature of for-profit firms

Economics of alternative therapies
Significance of Economics for Community Health Nursing Practice
Disease prevention/health promotion
Consumer-driven health care
Nurses can help consumers understand price and quality issues
Gaining third-party reimbursement—an important labor market change for nurses
Coalition building, research, lobbying, negotiating with insurers, influencing policymaking
Economics and Nightingale’s Legacy
Market justice
Social justice
Community Nursing – Discussion Questions
Chapter 13
Environmental Health
Trends in Exposure and Disease
World view

–Health risks from environmental toxicants

–Rapid increase in the world’s population

–Changes in urbanization and agricultural production

–Recent ecological changes

Population movement
Expanding urbanization
Change in agricultural practices
Environmental Health
Definition: freedom from illness or injury related to toxic agents and other environmental conditions

–Applications range from hospital rooms to international and global perspectives on health of the planet

Environmental Health Policy: Historical Perspectives
Early environmental health focused on sanitation, water quality, and housing

–Mortality rates decreased

Influential publication:

–Carson, R. (1962). Silent spring. Boston: Houghton Mifflin

Legislation and commissions

–Clean air and water acts

–Occupational health

–Safety acts

–Pollution Prevention Act of 1990

–Toxic Substances Control Act

–Environmental Protection Agency

–Occupational Safety and Health Administration Nuclear Regulation Commission

Recent Health Issues & Trends

–Damage to the environment

–Population growth

–Urban spread

–Advanced technology


–Modern agricultural methods


–Focus on the built environment

–Children’s environmental health

Chemicals, pesticides, mercury, smoke

–Environmental justice movement

Historical Perspectives on Environment and Health




Chronic disease epidemiology

–Asbestos and mesothelioma

–Prenatal exposure to diethylstilbestrol (DES)

–Occupational exposure

Origins of Environmental Health Policy
Industrial Revolution—1800s

–Focus on modernization and rapid production of goods and services

–Growing concern for working conditions and safety of workers


–Environmental health and safety

–Passages of laws to protect the public

–Pure Food and Drug Law

–Food and Drug Administration


–Post-war industrial rebuilding

–Consumer-driven environmental movement

Environmental Policy: Governmental Roles
Protect and safeguard
Pass laws and enact rules and regulations
Identify and monitor risks and hazards

–Healthy People 2020

Monitor compliance with rules
Gather data to inform policymakers
Nursing and the Environment

–Pure, fresh air

–Pure water

–Efficient drainage



Emerging Role

–Intervene directly in environmental factors

Role of the Community Health Nurse
Identify risks
Assess exposures
Communicate risks
Assess and refer clients
“Upstream Thinking”
Ethical Principles

–Social justice

–Environmental justice

Community Nursing – Discussion Questions

Chapter 9
Politics and the Law
Government Authority
Protection of the public’s health

–U.S. Constitution

–Bill of Rights

–State power

Power, Authority, and the
Health of the Public
Concepts of power








Evolution of the Government’s
Role in Health Care
Preamble of the U.S Constitution

–”Promote the general welfare” of the people

Marine Hospital Service
The Shattuck Report
Hill-Burton Act
Evolution of the Government’s
Role in Health Care (cont.)
Medicare & Medicaid
The Civil Rights Act of 1964
National Environmental Policy Act
Americans with Disabilities Act (ADA)
Affordable Care Act (ACA) of 2010
Federal Government


–Office of the President




–Federal Court System

U.S. Public Health Agencies
National Institutes of Health
Food and Drug Administration
Centers for Disease Control and Prevention
Indian Health Service
Health Resources and Services Administration
Substance Abuse and Mental Health Services Administration
Agency for Healthcare Research and Quality
U.S. Public Health Service Corps
Human Services Agencies
Centers for Medicare and Medicaid Services
Administration for Children and Families
Administration on Aging
Department of Education
Department of Labor
Legislative Branch
U.S. Congress

–Has two houses with equal power:

House of Representatives
Judicial Branch
94 federal districts courts
12 circuit courts of appeals
U.S. Supreme Court
Several specialized courts
State Government
Local Government
Public health
Public education
Drinking water
Sewage disposal
Police protection
Solid waste management
Different Types of Law
Constitutional law
Statutory law
Judicial or common law

–Civil or criminal

Regulation of Nursing Practice
Nurse practice acts of each state control:

–Requirements for entry into practice

–Standards for acceptable practice

–Standards for continuing competence

–Disciplinary actions

Board of Nursing
Licensure of Nursing Practice
National Council Licensing Examination for Registered Nurses (NCLEX-RN)
Nursing Practice and Law
Negligence and malpractice
Correctional settings
Forensic nursing
Chapter9   Chapter13   Chapter81

Community Nursing – Discussion Questions

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