4-6 pages on homelessness

• TOPIC: Addiction – Homelessness Abuse of alcohol, prescription drugs, tobacco, illegal substances.

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Biopsychosocial Population Health Policy Proposal

Kyla Hoag

NURS-FPX6026: Biopsychosocial Concepts for Advanced Nursing Practice

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Capella University

Kathryn Sheppard

October 5, 2022

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The Homeless Population and Addiction

Disparities in health care continue to exist in the United States despite spending lots of

time and attention addressing this issue. Vulnerable patients can be characterized as those with

increased risk for poor health conditions and difficulty obtaining health care access. Patients may

be considered vulnerable based on their physical abilities, psychological and cognitive status,

and social or ethnic differences. “These patients may face numerous obstacles and barriers when

seeking medical care, including (a) financial constraints, (b) difficulties with communication, (c)

difficulties understanding how to navigate the health care system, and (d) difficulties feeling

welcomed, respected, and safe” (Perry, et. al, 2018, p. 1835).

The homeless is an example of a vulnerable population and they face an assortment of

healthcare challenges, both physical and mental. The homeless population is susceptible to many

physical health related problems such as chronic pain, impaired mobility, impaired hearing or

vision, and obesity. The most common mental or psychological problem the homeless population

faced was post-traumatic stress disorder. “According to the 2013 AHAR, 257,000 people who

were homeless had a severe mental illness or a chronic substance abuse issue” (Mosel, 2022).

Homelessness causes a lack of stability, which can lead to drug addiction. However, people

already battling drug addiction are also at risk of becoming homeless. Homeless people with

mental health issues are at highest risk of addiction because they often self-medicate with street

drugs, and they use substances to numb the pain and stressors that comes with living on the

street. “According to the National Coalition for the Homeless, substance abuse is more prevalent

in people who are homeless than in those who are not” (Mosel, 2022). It can be challenging for

homeless people to stop using substances because they have smaller support networks and

decreased motivation. They also typically do not have easy access to traditional recovery

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programs, detox centers, and rehab programs. It is then crucial to look for a solution that will

allow the homeless population to effectively manage their chronic health conditions such as pain,

and to most importantly get them into a safe environment, where they do not have access to

substances to continue feeding their addiction.

Prescribing Precautions

“Chronic pain is thought to be common among homeless people, in part due to frequent

injuries and the high prevalence of concurrent health conditions” (Hwang et. al., 2011, p. 1).

Chronic pain is pain that persists past normal healing time, usually three months or more. It is

easy for this population to end up addicted to opioids and other substances because of chronic

pain. For some patients dealing with chronic pain, it is sometimes unrealistic for them to manage

their pain without prescribed opioid medications. “American Pain Society guidelines state for the

use of chronic opioid therapy in chronic non-cancer pain despite scant evidence, the expert panel

concluded that chronic opioid therapy could be effective therapy for carefully selected and

monitored patients with chronic non-cancer pain” (Manchikanti, et. al., 2012, p. S70). For

patients who are prescribed opioids for chronic pain, there needs to be screening tools and other

precautions put in place by the doctor’s office to prevent possible substance abuse. These

precautions may include regular face-to-face visits between providers and patients,

documentation of clinical course in electronic health records, and the use of prescription drug

monitoring programs (PDMPs). Many clinics have also implemented pain agreements between

the provider and patient that define conditions for opioid therapy. Some of these agreements

include picking up medications from only one pharmacy listed on file and yearly urine drug

screens. Violations in patient medication agreements often suggest a pattern of substance abuse.

“Pain medication agreements serve to standardize and reduce practice variation in opioid therapy

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to maximize benefit and mitigate potential harms and supplement universal opioid prescribing

precautions to reduce the risk of substance misuse” (Ghodke, et. al., 2020, p. 2155). Providing

education to the patient and patient’s family is also important. Signs and symptoms of overdose

should be provided to the patient and a prescription for Naloxone should be given to the patient.

For some patients, prescribing opioids for their chronic pain may be too unsafe and other

options should be considered. By incorporating a multidisciplinary approach to pain

management, patients might be able to find adequate pain relief without the harmful risks of

opioids. There are many opiate-free pain-relieving medications like acetaminophen, NSAIDs,

tricyclic antidepressants, and gabapentin, that are proven to be just as effective at improving

chronic pain. However, medications hardly treat all the components associated with pain,

because pain is considered a biopsychosocial phenomenon. “This means that an individual’s

underlying biological, psychological, cognitive, and social characteristics interact in a complex

way and in combination with both the situation and the environment, producing the individual’s

pain experience” (Eucker et. al., 2022, p. 2). A biopsychosocial method is vital to understanding

the pain experience as well as creating successful strategies for pain management. Non-

medication options include corticosteroid injections, interdisciplinary rehabilitation, exercise,

and cognitive behavioral therapy. “Multimodal treatments incorporate both pharmacologic and

nonpharmacologic strategies, have a growing evidence base, and are recognized as effective for

treating chronic pain” (Eucker et. al., 2022, p. 2). However, there is a major barrier to using

nonpharmacologic pain strategies and that is public and private insurance plans do not provide as

much coverage for these treatments, despite the evidence deeming them safe and important. For

example, the co-pay for a physical therapy session is much higher than the co-pay for a

prescription for opioid medications, and the number of sessions is restricted.

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Interprofessional Approach

Chronic pain is important to get under control, but most importantly, the homeless

population’s primary concern that needs to be addressed is housing. Substance abuse often

correlates directly with homelessness, therefore, the sooner the patient can find stable housing,

their chances of falling into addiction are drastically reduced. An interprofessional team should

be established to help develop this type of patient’s plan of care. This team should include: a

primary care provider, a pain specialist, nurses, a mental health professional such as a therapist or

psychiatrist, and social services. There needs to be coordination between inpatient and outpatient

social services as this population transitions into the community again.

“Government-funded rehab options like Housing First address a person’s housing issues first,

and then offer a personal choice as to whether the person wants to address their mental health

and substance abuse issues afterwards” (Mosel, 2022). Another way of supporting those

struggling with homelessness and a substance use disorder is known as a linear approach, which

its’ primary goal is to address the importance of obtaining abstinence as a way of eventually

obtaining stable housing.

Conclusion

Individuals experiencing homelessness face unusual challenges in accessing healthcare.

These challenges include lack of transportation, financial hardships, lack of insurance, and

negative encounters within the health care system. This ultimately results in poorer medical

outcomes and higher rates of health care consumption. Health professionals must know about

and acquire skills in navigating the resources available to this vulnerable population.

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References

Eucker, Knisely, M. R., & Simon, C. (2022). Nonopioid Treatments for Chronic Pain—

Integrating Multimodal Biopsychosocial Approaches to Pain Management. JAMA

Network Open., 5(6), e2216482–e2216482.

https://doi.org/10.1001/jamanetworkopen.2022.16482

Ghodke, A., Ives, T., Austin, A., Bennett, W., Patel, N., Eshet, S, & Chelminski, P. (2020). Pain

agreements and time-to-event analysis of substance misuse in a primary care chronic pain

program. Pain Medicine, 21(10), 2154-2162. https://doi.org/10.1093/pm/pnaa033

Hwang S., Wilkins E., Chambers C., Estrabillo E., Berends J., MacDonald A. (2011). Chronic

pain among homeless persons: Characteristics, treatment, and barriers to management.

BMC Fam Pract. 12(73), 2-9. https://doi.org/10.1186/1471-2296-12-73\

Manchikanti, L., Abdi, S., Atluri, S., Balog, C., Benyamin, R., Boswell, M., Brown, K., Bruel,

B., Bryce, D., Burks, P., Burton, A., Calodney, A., Caraway, D., Cash, K., Christo, P.,

Damron, K., Datta, S., Deer, T., Diwan, S., . . . Wargo, B. (2012). American society of

interventional pain physicians (ASIPP) guidelines for responsible opioid prescribing in

chronic non-cancer pain: Part 2 – guidance. Pain Physician, 15(3), S67-S116.

http://library.capella.edu/login?qurl=https%3A%2F%2Fwww.proquest.com

%2Fscholarly-journals%2Famerican-society-interventional-pain-physicians%2Fdocview

%2F2655995162%2Fse-2

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Mosel, S. (2022). Substance abuse & homelessness: statistics & rehab treatment. American

Addictions Center. Retrieved from https://americanaddictioncenters.org/rehab-

guide/homeless

Perry, H., Eisenberg, R., Swedeen, S., Snell, A., Siewart, B., & Kruskal, J. (2018). Improving

imaging care for diverse, marginalized, and vulnerable patient populations.

RadioGraphics. 38, 1833–1844. https://doi.org/10.1148/rg.2018180034

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Running head: ANALYSIS OF POSITION PAPERS 1

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Analysis of Position Papers for Vulnerable Populations

Learner’s Name

Capella University

Biopsychosocial Concepts for Advanced Nursing Practice II

Analysis of Position Papers for Vulnerable Populations

October, 2018

ANALYSIS OF POSITION PAPERS 2

Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.

Analysis of Position Papers for Vulnerable Populations

As a group, veterans present a complicated, vulnerable population for the health care

industry. Reports show that more than half of the U.S. Department of Veterans Affairs’ primary

care patients state that they have pain, several of whom report chronic pain. Patients suffering

from chronic pain often have higher levels of medical utilization, more disability claims,

diminished productivity at work, and a poorer quality of life compared to patients who do not

suffer from chronic pain. Further, it has been observed that the latter present with higher rates of

alcohol and substance use disorders (Lovejoy, Dobscha, Turk, Weimer, & Morasco, 2016).

The need for pain management was advocated and discussed in the 1980s and 1990s.

Groups such as the WHO took a stand on how to address pain as a health care issue, particularly

with reference to how cancer and cancer treatment affects patient lives. It was argued that it is

unethical for any patient to be dying in pain, even if the treatment hastens death. This mandate

was initially meant for cancer patients with chronic pain; however, over time, it has been

extended to include chronic noncancer pain as well (Sullivan & Howe, 2013). One of the

treatments recommended at the time was using opioids to manage pain. However, studies have

since confirmed that a significant link exists between prescription opioid treatment and opioid

addiction (Compton, Jones, & Baldwin, 2016; Kolodny, Courtwright, Hwang, Kreiner, Eadie,

Clark, & Alexander, 2015; Volkow & McLellan, 2016). Veterans as a population are particularly

vulnerable in this situation given that many of them deal with both physiological pain and

psychological issues including post-traumatic stress disorder and substance abuse disorder

(Sullivan & Howe, 2013). It is then necessary to look for a solution that allows veterans dealing

with pain to manage it effectively and, further, to regulate and control the use of opioids to

minimize the risk of addiction as well as the potentially dangerous side effects of opioid use.

ANALYSIS OF POSITION PAPERS 3

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Pain Relief Management and the Opioid Crisis

The guidelines issued by the WHO and the Declaration of Montreal issued by the

International Association for the Study of Pain state that if patients suffer from chronic pain, it is

unethical to let them remain in pain (Sullivan & Howe, 2013). However, there is a line that

separates the management of pain and the abuse of medication. Studies have shown that opioids

do provide significant pain relief in modest doses over a short period of treatment. However, the

long-term efficacy of opioids for pain relief management has not been proven to be clinically

significant (Sehgal, Colson, & Smith, 2013).

The management of pain to improve quality of life and the possibility of medication

abuse and addiction are two sides of the opioid issue. The position that the American Academy

of Neurology takes on the issue reiterates earlier studies that show that the efficacy of opioid

medication might not extend to a long-term prescription of opioids. The current state of opioid

prescription practices has been associated with significant morbidity and high rates of mortality

(Franklin, 2014). On a similar note, The American Osteopathic Academy of Addiction Medicine

(n.d.) issued a public policy statement on the use of naloxone, an opioid antagonist that blocks

opioid receptor activation and, through this, reverses opioid overdoses by preventing or reversing

respiratory arrest.

The American Society of Addiction Medicine (2016) also suggests a similar course of

action in terms of educating individuals on the use of naloxone. It also encourages those close to

the individual experiencing an opioid overdose to educate themselves on how to detect the onset

of an overdose. The same association presents the rising statistics associated with prescription

opioids and the necessity of raising awareness about the dangers associated with opioids and

educating people on the treatment of an opioid overdose. The American Society of Addiction

ANALYSIS OF POSITION PAPERS 4

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Medicine recommends co-prescribing naloxone with opioids for people who might be at risk of

overdose and educating both the patient and those close to the patient on how to properly use a

naloxone kit.

Ethical Pain Management versus the Possibility of Addiction

The above papers focus on ensuring that the public and individuals prescribed opioids are

made aware of the dangers associated with the use of opioids. The addictive properties of opioids

and the epidemic of opioid overdoses that has spread over the past few decades are indicators of

the severity of the situation (Kolodny et al., 2015). The other side of the argument is that opioid

treatment is a necessity for many in chronic pain. In Sullivan and Howe’s 2013 study on opioid

therapy for chronic pain, the authors recount the history of the opioid crisis. The shift toward the

use of opioids in the treatment of pain was marked by the WHO issuance of guidelines for the

use of opioids in the context of pain relief for cancer patients in 1985 and 1996. This was

eventually extended to noncancer pain as well. The underlying logic at work was that chronic

noncancer pain could be debilitating to the same extent as cancer pain over longer periods of

time and with greater rates of prevalence.

There are two aspects to the counterargument presented by supporters of opioid

treatment. The first is that pain as a symptom or consequence of injury or illness can lead to

inferior quality of life, resulting in psychological difficulties and even impeding recovery

(Manjiani, Paul, Kunnumpurath, Kaye, & Vadivelu, 2014). The second aspect is that opioid

treatment potentially provides a long-term solution for chronic pain. This claim is made largely

as an extension of the efficacy that can be seen in short-term studies of opioid treatment

(Franklin, 2014).

ANALYSIS OF POSITION PAPERS 5

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However, as there exists very little evidence on the long-term efficacy of opioid

treatment, it becomes problematic that opioid treatment is already in practice to relieve chronic

noncancer pain. In the American Academy of Neurology’s position paper on the use of opioids

for chronic noncancer pain, Franklin (2014) analyzes both the rise of opioids as a treatment as

well as the epidemic of addiction and overdose that came about as a result of the advocacy for

opioid treatment. Aside from the dangers of addiction that individuals face, Franklin also

addresses the significant side effects that opioids present when taken over long durations,

including opioid-induced hyperalgesia, immunosuppression, infertility, and hypogonadism.

Newhouse states that opioid drugs were prescribed to over 400,000 veterans for pain

relief, which correlates to approximately 1.7 million opioid prescriptions (as cited in Snow &

Wynn, 2018). The effort to manage the chronic pain that veterans face, however, presents with

its own unique set of complications, particularly because of how widespread the use of opioid

treatment has become. Baser, Xie, Mardekian, Schaaf, Wang, and Joshi state that veterans are

approximately seven times more likely to abuse opioids than civilians (as cited in Snow &

Wynn, 2018). Further, opioids are more likely to be prescribed to individuals who have a history

of substance abuse and mental health issues, and this would result in unfavorable or harmful

outcomes such as drug abuse or opioid overdose (Howe & Sullivan, 2014). When considering

this with the prevalence of psychological issues and chronic physiological pain that many

veterans present with, it becomes apparent that long-term treatment with opioids for veterans is

not advisable.

Kissin found that 35% of veterans who were admitted to Tuscaloosa Veterans Affairs

Medical Center’s acute inpatient psychiatric unit presented with severe post-traumatic stress

disorder symptoms, coupled with issues such as suicidal ideation and mood disturbances. Kissin

ANALYSIS OF POSITION PAPERS 6

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also found that 25% of these veterans had an underlying case of opioid use disorder (as cited in

Snow & Wynn, 2018). To treat veterans such as these who are comorbid with chronic pain and

behavioral issues, it is necessary to integrate the psychological and the psychiatric into the model

of care to sufficiently address the overall health of the patient (Snow & Wynn, 2018). Such a

model would require physicians, psychologists, and psychiatrists to simultaneously address the

needs of the patient. One of the issues they might encounter is managing the patient’s

prescriptions. Denenberg and Curtis and Hawkins et al. note that opioids are contraindicated for

patients with substance-abuse issues (as cited in Snow & Wynn, 2018); physicians and mental

health specialists would have to come to some resolution to mediate the patient’s need for pain

relief and the patient’s potential for abuse of his or her medication.

Weiss et al. (2014) note that individuals who present with post-traumatic stress disorder

and substance abuse disorder are likely to use opioids to relieve negative emotional states, aid

sleep, or relieve pain. Crowley, Kirschner, Dunn, and Bornstein (2017) suggest that behavioral

health should be taken into consideration while evaluating the overall health of the individual.

The purpose of opioid treatment is to improve the patient’s quality of life with respect to the

reduction of pain. Therefore, there should be a simultaneous push toward counseling to address

the overall health of the individual and not solely focus on pain. This would involve coordination

between counselors and physicians who specialize in pain management to effectively improve

the quality of life for these patients.

Conclusion

The management of chronic pain with long-term opioid treatment involves significant

risk and does not have clinically significant evidence to support its use. Veterans present a

complicated population because many of them deal with mental health issues such as post-

ANALYSIS OF POSITION PAPERS 7

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traumatic stress disorder and substance abuse disorder as well as chronic pain. An analysis of

policies of various institutions and position papers on the use of opioids for pain management

brings into focus the severity of the opioid crisis. Most position papers take the stance that long-

term opioid treatment would not be advisable given the lack of evidence to support it. Further,

the abundance of public policy statements that advocate educating individuals on the use of

naloxone, an opioid antagonist, indicates the severity of the crisis in the present context. One

effective response to the existing crisis might be to simultaneously provide counseling along

with opioid treatment to address the individual’s overall health. The comorbidity of behavioral

issues and chronic pain in veterans indicates that they are a particularly vulnerable population,

with a high risk of addiction and prescription drug misuse. Therefore, to provide efficient,

holistic care, it is necessary to evaluate the efficacy of long-term opioid treatment and the

guidelines associated with it.

ANALYSIS OF POSITION PAPERS 8

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References

American Society of Addiction Medicine. (2016). Use of naloxone for the prevention of opioid

overdose deaths. Retrieved September 27, 2018, from https://asam.org/advocacy/find-a-

policy-statement/view-policy-statement/public-policy-statements/2014/08/28/use-of-

naloxone-for-the-prevention-of-drug-overdose-deaths

Compton, W. M., Jones, C. M., & Baldwin, G. T. (2016). Relationship between nonmedical

prescription-opioid use and heroin use. The New England Journal of Medicine, 374(2),

154–163. Retrieved from http://floridahealth.gov/statistics-and-data/e-forcse/news-

reports/_documents/NEJM-opioid-heroin-use

Crowley, R., Kirschner, N., Dunn, A. S., & Bornstein, S. S. (2017). Health and public policy to

facilitate effective prevention and treatment of substance use disorders involving illicit

and prescription drugs: An American College of Physicians position paper. Annals of

Internal Medicine, 166(10), 733–736. http://dx.doi.org/10.7326/M16-2953

Franklin, G. M. (2014). Opioids for chronic noncancer pain: A position paper of the American

Academy of Neurology. Neurology, 83(14), 1277–1284. Retrieved

from

https://doi.org/10.1212/WNL.0000000000000839

Howe, C. Q., & Sullivan, M. D. (2014). The missing ‘P’ in pain management: How the current

opioid epidemic highlights the need for psychiatric services in chronic pain care. General

Hospital Psychiatry, 36(1), 99–104. https://doi.org/10.1016/j.genhosppsych.2013.10.003

Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., &

Alexander, G. C. (2015). The prescription opioid and heroin crisis: A public health

approach to an epidemic of addiction. Annual Review of Public Health, 36(1), 559–574.

https://doi.org/10.1146/annurev-publhealth-031914-122957

ANALYSIS OF POSITION PAPERS 9

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Lovejoy, T. I., Dobscha, S. K., Turk, D. C., Weimer, M. B., & Morasco, B. J. (2016). Correlates

of prescription opioid therapy in veterans with chronic pain and history of substance use

disorder. Journal of Rehabilitation Research and Development, 53(1), 25–36.

http://dx.doi.org/10.1682/JRRD.2014.10.0230

Manjiani, D., Paul, D. B., Kunnumpurath, S., Kaye, A. D., & Vadivelu, N. (2014). Availability

and utilization of opioids for pain management: Global issues. Ochsner Journal, 14(2),

208–215. Retrieved from

http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocvie

w%2F1541487990%3Faccountid%3D27965

Sehgal, N., Colson, J., & Smith, H. S. (2013). Chronic pain treatment with opioid analgesics:

Benefits versus harms of long-term therapy. Expert Review of Neurotherapeutics, 13(11),

1201–1220. http://dx.doi.org/10.1586/14737175.2013.846517

Snow, R., & Wynn, S. T. (2018). Managing opioid use disorder and co-occurring posttraumatic

stress disorder among veterans. Journal of Psychosocial Nursing and Mental Health

Services, 56(6), 36–42. http://dx.doi.org/10.3928/02793695-20180212-03

Sullivan, M. D., & Howe, C. Q. (2013). Opioid therapy for chronic pain in the US: Promises and

perils. Pain, 154(Suppl 1), S94–100. Retrieved from

https://ncbi.nlm.nih.gov/pmc/articles/PMC4204477/

The American Osteopathic Academy of Addiction Medicine. (n.d.). Naloxone public policy

statement: The use of naloxone for the prevention of opioid overdose deaths. Retrieved

from

https://c.ymcdn.com/sites/www.aoaam.org/resource/resmgr/Docs/AOAAM_NALOXON

E_POLICY_2015

ANALYSIS OF POSITION PAPERS 10

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Volkow, N. D., & McLellan, A. T. (2016). Opioid abuse in chronic pain — misconceptions and

mitigation strategies. The New England Journal of Medicine, 374(13), 1253–1263.

Retrieved from http://pcpr.pitt.edu/wp-content/uploads/2018/01/Volkow-McLellan-

2016

Weiss, R. D., Potter, J. S., Griffin, M. L., McHugh, R. K., Haller, D., Jacobs, P., Rosen, K. D.

(2014). Reasons for opioid use among patients with dependence on prescription opioids:

The role of chronic pain. Journal of Substance Abuse Treatment, 47(2), 140–145.

http://doi.org/10.1016/j.jsat.2014.03.004

· Develop a 4-6 page position summary and an analysis of relevant position papers on a health care issue in a chosen population.

Introduction

Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.

Position papers are a method to evaluate the most current evidence and policies related to health care issues. They offer a way for researchers to explore the views of any number of organizations around a topic. This can help you to develop your own position and approach to care around a topic or issue.

This assessment will focus on analyzing position papers about an issue related to addiction, chronicity, emotional and mental health, genetics and genomics, or immunity. Many of these topics are quickly evolving as technology advances, or as we attempt to push past stigmas. For example, technological advances and DNA sequencing provide comprehensive information to allow treatment to become more targeted and effective for the individual. However, as a result, nurses must be able to understand and teach patients about the impact of this information. With this great power comes concerns that patient conditions are protected in an ethical and compassionate manner.

Position papers are a way for individuals, groups, and organizations to express their views and intentions toward a specific issue. In health care, many position papers address specific policies, regulations, or other approaches to care. As a master’s-prepared nurse, you should feel empowered to express and advocate for your own views on policy and care matters. This is especially important when it comes to populations you or your organization cares for that are not receiving the quality, type, or amount of care that they require.

An important skill in creating a position paper or policy proposal is the ability to analyze and synthesize others’ views about the population or issue of interest to you. By synthesizing the positive and negative views of an issue, you can become better equipped to strengthen your own arguments and respond to opposing views in an informed and convincing way.

Professional Context

Position papers are a way for individuals, groups, and organizations to express their views and intentions toward a specific issue. In health care, many position papers address specific policies, regulations, or other approaches to care. As a master’s-prepared nurse, you should feel empowered to express and advocate for your own views on policy and care matters. This is especially important when it comes to populations you or your organization cares for that are not receiving the quality, type, or amount of care that they require.

An important skill in creating a position paper or policy proposal is the ability to analyze and synthesize others’ views about the population or issue of interest to you. By synthesizing the positive and negative views of an issue, you can become better equipped to strengthen your own arguments and to respond to opposing views in an informed and convincing way.

Scenario

For this assessment, pretend you are a member of an interprofessional team that is attempting to improve the quality and outcomes of health care in a vulnerable population. For the first step in your team’s work, you have decided to conduct an analysis of current position papers that address the issue and population you are considering.

In your analysis, you will note the team’s initial views on the issue in the population as well as the views across a variety of relevant position papers. You have been tasked with finding the most current standard of care or evidenced-based practice and evaluating both the pros and cons of the issue. For the opposing viewpoints, it is important to discuss how the team could respond to encourage support. This paper will be presented to a committee of relevant stakeholders from your care setting and the community. If it receives enough support, you will be asked to create a new policy that could be enacted to improve the outcomes related to your chosen issue and target population.

The care setting, population, and health care issue that you use for this assessment will be used in the other assessments in this course. Consider your choice carefully. There are two main approaches for you to take in selecting the scenario for this assessment:

1. You may select a population and issue that is of interest to you and set them in the context of your current or desired future care setting. While you are free to choose any population of interest, the issue you choose should fall within one of the following broad categories:

1. Genetics and genomics.

1. ADDICTION.

ABUSE OF ALCOHOL, HOMELESSNESS PRESCRIPTION DRUGS, TOBACCO, ILLEGAL SUBSTANCES.

Note: If you choose the second option, contact your faculty to make sure that your chosen issue and population will fit within the topic areas for this course.

Instructions

For this assessment, you will develop a position summary and an analysis of relevant position papers on a health care issue in a chosen population. The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your assessment submission addresses all of them. You may also want to read the Analysis of Position Papers for Vulnerable Populations Scoring Guide and 

Guiding Questions: Analysis of Position Papers for Vulnerable Populations [DOC]

 to better understand how each grading criterion will be assessed.

. Explain a position with regard to health outcomes for a specific issue in a target population.

. Explain the role of the interprofessional team in facilitating improvements for a specific issue in a target population.

. Evaluate the evidence and positions of others that could support a team’s approach to improving the quality and outcomes of care for a specific issue in a target population.

. Evaluate the evidence and positions of others that are contrary to a team’s approach to improving the quality and outcomes of care for a specific issue in a target population.

. Communicate an initial viewpoint regarding a specific issue in a target population and a synthesis of existing positions in a logically structured and concise manner, writing content clearly with correct use of grammar, punctuation, and spelling.

. Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.

Example assessment: You may use the 

Assessment 1 Example [PDF]

 to give you an idea of what a Proficient or higher rating on the scoring guide would look like.

Submission Requirements

. Length of submission: 4–6 double-spaced, typed pages, not including the title and reference pages. Your plan should be succinct yet substantive. No abstract is required.

. Number of references: Cite a minimum of 3–5 sources of scholarly or professional evidence that support your initial position on the issue, as well as a minimum of 2–3 sources of scholarly or professional evidence that express contrary views or opinions. Resources should be no more than five years old.

. APA formatting: Use the 

APA Style Paper Template [DOCX]

 and the 

APA Style Paper Tutorial [DOCX]

to help you in writing and formatting your analysis.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

. Competency 1: Design evidence-based advanced nursing care for achieving high-quality population outcomes.

. Evaluate the evidence and positions of others that could support a team’s approach to improving the quality and outcomes of care for a specific issue in a target population.

. Evaluate the evidence and positions of others that are contrary to a team’s approach for improving the quality and outcomes of care for a specific issue in a target population.

. Competency 2: Evaluate the efficiency and effectiveness of interprofessional interventions in achieving desired population health outcomes.

. Explain the role of the interprofessional team in facilitating improvements for a specific issue in a target population.

. Competency 3: Analyze population health outcomes in terms of their implications for health policy advocacy.

. Explain a position with regard to health outcomes for a specific issue in a target population.

. Competency 4: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards.

. Communicate an initial viewpoint regarding a specific issue in a target population and a synthesis of existing positions in a logically structured and concise manner.

. Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.